The retractable wheelchair.
Assistive technology is more than mobility help for senior citizens and handicapped persons; it helps nurses and caregivers as well.
Projections indicate that by 2030, Malaysia will be in the category of ageing nations, with older persons constituting more than 15% of the population.1 In this context, infrastructure and devices that are able to assist the elderly, particularly in moving around, are urgently needed.
In the US, just over 6.8 million community-resident Americans use assistive devices to help them with mobility. This group comprises 1.7 million wheelchair or scooter riders and 6.1 million users of other mobility devices, such as canes, crutches and walkers.2 Stroke and osteoarthritis are the two most prevalent primary conditions among wheelchair and scooter users, with osteoarthritis accounting for 1.2 million mobility device users.
Assistive technology refers to “assistive, adaptive and rehabilitative devices for people with disabilities, including the process used in selecting, locating and using them. Assistive technology promotes greater independence by enabling people to perform tasks that they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks.”3
Sometimes, people use the term “adaptive technology” interchangeably with “assistive technology”. However, these terms are not synonymous; adaptive technology covers items specifically designed for persons with disabilities and are seldom used by non-disabled persons.
In healthcare facilities and homes where there are handicapped persons, healthcare workers continually lift, re-position and transfer patients who have limited mobility. Larger patients can frequently pose particular challenges for “safe handling” because the burden of their weight can sometimes lead to injury for their nurses and caregivers.
According to a report by the American Society of Safety Engineers (ASSE), healthcare workers reported two million lost workdays due to injury in 2011. Injuries to healthcare workers cost US$13bil, with hospital worker injury accounting for US$6.1mil.4 In hospitals, nursing and residential care facilities, and ambulatory care, additional costs were passed down to patients with higher healthcare costs.
Data from the US Bureau of Labor Statistics show that in 2014, the rate of over-exertion injuries averaged across all industries was 33 per 10,000 full-time workers.5 By comparison, the over-exertion injury rate for hospital workers was twice the average (68 per 10,000), the rate for nursing home workers was over three times the average (107 per 10,000), and the rate for ambulance workers was over five times the average (174 per 10,000). The single greatest risk factor for over-exertion injuries in healthcare workers is the manual lifting, moving and re-positioning of patients, residents or clients, i.e., manual patient handling.
A 2013 study of Workplace Safety and Health in 10 Singapore healthcare institutions, employing two-fifths of the healthcare workforce in Singapore, found that 23.6% of 72 workplace injury cases at these institutions resulted from over-exertion while handling, lifting or carrying objects.6 These injuries resulted in more than three days of workday leave.
The Retractable Wheelchair
Today, there is a more comfortable option for the disabled, senior citizens, healthcare workers and home caregivers. An innovation in wheelchair design has produced a retractable wheelchair that claims to be the world’s first transfer wheelchair.7
Pang showing the wheelchair in its retracted form.
A Nanyang Polytechnic invention, the retractable wheelchair was the result of a school project given by a lecturer to his class of final-year undergraduates in the department of engineering. Nanyang Polytechnic was the first to offer nursing courses at the tertiary level in Singapore, graduating over 20,000 students to date. While training in the use of the wheelchair, nursing students found that the wheel seemed to be “in the way” and wondered whether it was possible to remove it. So they challenged the department of engineering to come up with a solution; the outcome was the retractable wheelchair.
The first prototype designed by the undergraduates was quite rough, but when Michael Pang, an entrepreneur and vice president of the Association of Medical Device Industry in Singapore, saw the potential, he signed the deal with Nanyang Polytechnic, paid the patent fees, redesigned, moulded and re-cast for a year to build, with the help of his friends in the industry, a commercial product. The finished product is a retractable wheelchair where the rear wheel on either or both sides can be retracted to facilitate easier positioning of the transfer board8 and increase the stability of the patient or disabled person during lateral transfer.
Formerly a caregiver to his late mother, Pang knows just how heavy a disabled or handicapped person can be when he or she is inert or incapable of moving independently, or even with assistance. “Deadweight” is the term used for the excess weight an inert person has. This excess weight can be a burden to nurses and caregivers who have to struggle with the transfer of the handicapped person from, for example, the wheelchair to the bed. The manual lifting procedure can take more than 20 minutes and can involve more than two able-bodied individuals. Such a transfer can actually injure the non-disabled persons, leaving them sometimes with permanent back pain or injury.
Pang’s motivation stems from his deep compassion and understanding of the needs of the physically challenged. “Many of us will be caregivers sooner or later. The more we know about proper transfer, the better for us,” says Pang. “When you are a nurse, you might do manual lifting seven times a day for one patient. You are not keen to use the mechanical hoist because it is too troublesome.
“Just think: you have 40 patients in the ward; your back will break! This is why nursing is a backbreaking job. If a nurse has back injury, the minimum medical certificate could give her two weeks of leave; the longest is five to six weeks. You will need to employ part-time staff, reschedule… On-the-job lifting injuries can cost more than the wheelchair.”
Pang’s biggest obstacle is changing mindsets. According to him, Singapore imports more than 20,000 wheelchairs a year. Many people buy because of the price factor: “Sometimes people do not know how to buy the correct wheelchair and end up buying a second one. Education is very important.”
Statistics show that Malaysia’s population is still relatively young, but changes in age structure resulting from fertility decline and increased longevity are contributing toward an ageing population. Malaysia’s total population of older persons in 2012 was 8.2% of the total population of the country (2.4 million out of 29.34 million).9
With this development, every little bit helps. Assistive technology such as the retractable wheelchair has the potential to contribute to better health, not only for our senior citizens but also for their caregivers.
8 A transfer board, best used by patients who can bear weight briefly with their arms, is a long, smooth board, usually about two feet long. It is used to help transfer a patient to another seated position on a chair, bed or wheelchair.