Engineers and industrial designers have different approaches to problem solving. Both place heavy emphasis on identification of customer needs, manufacturing methods, and prototyping. Industrial designers focus on aesthetics, ergonomics, ease of use, manufacturing methods, and the user's experience. They tend to be more visual and more concerned with the interaction between users and products. Engineers focus on functionality, performance requirements, analytical modeling, and design verification and validation. They tend to be more analytical and more concerned with the design of internal components and product performance. Engineers and industrial designers often work together on project teams in industry. Collaboration between the two groups on senior capstone design projects can teach each to respect and value the unique contributions each brings to the project team, result in improved design solutions, and help prepare students for future collaboration in industry. Student feedback and lessons learned by faculty and students from a ten-year collaboration between engineering and industrial design students from Marquette University and the Milwaukee Institute of Art and Design, respectively, are presented. Students learned to communicate with people in other disciplines, appreciate the complementary skills of each discipline, and value different approaches to problem solving.

Background/Objective: Prone carts are used for mobility. by individuals with spinal cord injury in whom seated mobility (wheelchair) is contraindicated due to ischial or sacral pressure ulcers. Currently available prone carts are uncomfortable, subjecting the user to neck and shoulder strain, and make social interaction and performing activities of daily living difficult. A better design of prone carts is needed. In addition, standing devices have shown some medical benefits. The objective was to design and evaluate an improved prone cart that facilitates standing.Design: Engineering development project with user feedback through questionnaire. Users selected by convenience sampling.Methods: A marketing survey was performed of nurse managers of spinal cord injury units. Then 2 prototype carts were designed and built. These carts are able to tilt up to 45 degrees and have a joystick-controlled motor for propulsion and other design features, including a workspace storage shelf and rearview mirrors. The carts were evaluated by both patients and caregivers at 2 Veteran's Administration hospitals.Outcome Measures: Questionnaire of subjects, both patients and caregivers, who used the cart.Findings: Both patients and caregivers liked the carts and the ability to assume a nonhorizontal body angle. The major complaint about the cart was that it seemed too long when it came to making turns.Conclusion: This prone cart design is an improvement over the standard, flat variety. However, further design changes will be necessary. This study provided valuable information that will be useful in the next-generation prone cart design project.

This paper summarizes a series of projects funded since 1992 to address the compelling need to improve the quality of life for persons with spinal cord dysfunctions who use prone carts. Specifically, Veterans Services Organization, National Institute on Disability and Rehabilitation Research (NIDRR), and the VA Rehabilitation Research and Development funded studies to develop new consumer-driven designs for prone carts. Using an iterative approach, this team of clinicians and designers (1) evaluated existing prone carts; (2) designed a new manual prone cart; (3) designed a new motorized prone cart, including a standing model; and (4) are collaborating with manufacturers to market and commercialize the new prone carts. Prototypes were developed at the Milwaukee Institute of Art and Design with the assistance of Ortho-Kinetics, Inc., and Everest & Jennings and were clinically evaluated at two Veterans Affairs Medical Centers (Tampa and Milwaukee) with patients and caregivers and for compliance with applicable ISO (International Organization for Standardization) for electric wheelchair standards.

The purpose of these projects was to design new and safe commode-shower wheelchairs for use by individuals with spinal cord injuries and caregivers. The need for new chairs resulted from the many safety problems associated with existing models such as inability to fold, patient falls while transferring, development of pressure sores. An iterative process of design, prototype fabrication and clinical evaluation was used to develop both a rigid and a folding shower-commode wheelchair. During this process, new wheelchair features were invented and patented. The shower-commode wheelchairs were successfully evaluated with patients having spinal cord injuries and their caregivers at VA Medical Centers. Questionnaires were developed to assess the chair's features and function. The evaluation results led to the conclusion that the new Shower-Commode Wheelchairs solved all the safety and usability problems found in existing models.

Nurses have a responsibility to monitor patient safety related to the use of equipment. Existing bowel care/shower chairs used by persons with neurogenic bowel can pose serious safety risks for patients. Twenty-four percent of persons with spinal cord dysfunction reported development of pressure ulcers and cuts from the seats, and 35% reported a history of falls from bowel care/shower chairs. Of those who reported injuries due to falls, more than 23% reported that they were hospitalized from 1 month to 4 years due to injuries from the fall. Many of the pressure ulcers and falls that occur from the use of bowel care equipment can be prevented. A combination of design flaws and user error are responsible for these safety risks. Design flaws in existing equipment include seat design, seat configuration, footrests, armrests, hand rims that are difficult to propel when wet, unreliable brakes, and chair frame instability. User error that contributes to pressure ulcers relates to poor posture in the chair. User error that contributes to patient falls relates to leaning over to wash the feet and lack of maintenance of air pressure in the tires, which affects the brakes. A series of research and development projects enabled the authors to design a new bowel care/shower chair that incorporates many new features and inventions to enhance patient safety.

ADA accessibility guidelines are based primarily on the capabilities of young people, and as such may not compensate adequately for the range of comorbidities and secondary conditions that are common among older people with disabilities. This paper reviews findings from three studies of toilet transfer which suggest that ADA accessibility guidelines (ADAAG) for toilet and grab bar configurations do not meet the needs of older adults. The first study, a nationwide survey of people with mobility impairments, assessed difficulty with ADA-compliant and other toilet/grab bar configurations. The second, a laboratory study of grab bar use, evaluated the effectiveness of different grab bar configurations. Finally, the third study evaluated four new toilet designs with built-in handholds to facilitate transfer. Collectively, these studies indicate that there is a need for alternative ADA Accessibility Guidelines for the Elderly (ADAAGE)

The purpose of this development project was to design a new commode-shower chair that can be safely used by individuals with spinal cord injuries (SCI) and their caregivers. The need for this new design was consumer-driven. Patients and caregivers identified the following fatal flaws in the commode-shower chairs used in Spinal Cord Injury (SCI) centers: 1) risk for patient falls during transfers, propelling, and while leaning over for showering; 2) risk for pressure ulcers due to inadequate padding and seat positioning for lengthy bowel care regimes; 3) inadequate caregiver access to the perianal area of the patient to perform bowel care procedures; and, 4) wheel-related inability to properly position the chair directly over the toilet. The new, self-propelled chair addresses each of these concerns. Lockable, swing-away, pivoting armrests and improved, lever-activated brakes were designed to facilitate safe transfers. An innovative foot-lift was invented to facilitate washing of feet. Larger handrims were designed to aid in propulsion in wet environments. To prevent pressure ulcers, a chair frame and padding combination was designed to facilitate a seating position that optimally distributes body weight to prevent the development of pressure ulcers in the sacral and ischial areas. To address the common risk of heel ulcers, footrests, featuring edgeless, rounded heel cups, were designed. A new tubular chair frame, a new seat and smaller wheels were designed to enhance caregiver access and ensure proper chair positioning over the toilet. Following its successful clinical evaluation at the Milwaukee and Tampa VA Medical SCI Centers, the Advanced commode-shower chair is being patented by the Department of Veterans Affairs (VA). The VA has partnered with Everest & Jennings, to make this chair available commercially.

Prone carts are used for mobility by individuals with spinal cord injury who cannot use a wheelchair due to the risk of aggravating existing pressure ulcers. A prone cart is a flat/horizontal cart with a fixed height, propelled by the user while laying in a prone position. Patients reported that prolonged use of a prone cart resulted in chronic neck, shoulder and back pain. Additionally the existing prone carts lack user accessible angle adjustability, chest support area, as well as a storage, eating or working area. An interdisciplinary research team collaborated to address these concerns. Three prone carts were evaluated: E&J, Gendron, and a newly developed prototype, MIAD/PVA. Questionnaires were administered to caregivers and patients regarding usage and effectiveness of the prone carts as well as the features of an ideal cart. This data led to the design and refinement of a prototype prone cart which was tested on 20 patients and 19 caregivers at the SCI Centers of the Milwaukee and Tampa VAMC's from 1994-1995. The new prone cart enables the user to lie at an angle rather than laying flat. This position has been found to relieve back and neck pressure. With an hydraulic system, the the user can adjust both the front and rear angles of the cart to achieve desired comfort. In addition, a front deck provides an eating and working area. This study resulted in research-based information and criteria for the design of new prone carts. Findings of this pilot study will be incorporated in a development merit review proposal to the VA Rehabilitation Research & Development service for the design of a new manual and motorized prone cart. The researchers are collaborating with Ortho-Kinetics Inc. to promote ease in manufacturing.

Pressure, positioning, and postural support are critical aspects in the design of a new bowel care/shower chair for persons with spinal cord injuries (SCI). The purpose of this evaluation was to evaluate seating pressures on three existing bowel care/shower chairs commonly used by persons with spinal cord injuries. A pressure mapping device, the Force Sensing Array, was used to measure seat pressure, position and postural support. Three seated subjects with spinal cord injuries were evaluated on each of the following three bowel care/shower chairs: Lumex, TRAUM-AID and E&J. The results of this evaluation will be briefly presented. This study is part of a larger study to design a bowel care/shower chair that uniquely meets the needs of persons with spinal cord injury.

46% of the 277 SCI veterans responding to the survey used bowel care/shower chairs at home. Of those who regularly used these chairs (N = 147), over 66% felt their safety was compromised by their use. Caregivers reported similar dissatisfaction with existing bowel care/shower chairs. Primary concerns related to difficulty in assisting with safe transfers were, lack of hand access to perianal area for digital stimulation, lack of ease in rolling and turning the chair, difficulty in keeping the chair clean, and lack of durability of chair, particularly with brakes and seat. Primary safety risks included patient falls and pressure ulcer development. Reports of chair related patient falls (35%) and pressure ulcers (24%) were common in the SCI patients surveyed. Less than 54% were satisfied with the design and usability of bowel care/shower chairs.

Bowel care is a critical aspect of daily living for person with disabilities; ineffective bowel care can lead to severe and costly complications. Staff, patients, and caregivers have often found existing bowel care chairs to be inadequate. These chairs are frequently unsafe, inconvenient, and ineffective for showering and bowel elimination. Because bowel care procedures can be lengthy, proper seating posture and comfort is necessary to prevent pressure ulcers. Patient falls is another common problem, occurring during transfer, transport, or during actual bowel care/shower procedures. There are over 200,000 persons with spinal cord injuries (SCI) in the United States today. The majority of these patients have neurogenic bowels, requiring bowel care an average of three times a week. Each bowel care procedure takes 30 minutes to 3 hours to complete. Advances in bowel care chair design would significantly impact on quality of life, self-esteem, and physical well-being of persons with SCI. Enhanced design would also improve the safety, effectiveness, and efficiency of nurses and caregivers who perform bowel care procedures. An interdisciplinary research team, comprised of an industrial designer, a nurse, two physicians, and a human factors psychologist collaborated to address this important problem. Three bowel care chairs, commonly used in SCI, were evaluated using a combination of videotaping, still photography, and questionnaires. Based on this data, performance criteria for the design of an optimal bowel care chair design were developed.

A postal opinion survey examined several issues related to use of home modifications, bathrooms and bathroom fixtures by 783 adults with disabilities. Key research issues included the following questions: 1. What are the types of approaches and transfers to bathtubs and toilets made by non-ambulatory people, and how do they differ from the approaches and transfers of those who are semi-ambulatory? 2. How effective are grab-bars in transferring to and from the bathtub or the toilet? 3. What are the design features of the lavatory which are liked or disliked by semi and non-ambulatory users? Of those responding to the questionnaire, 60% were older than 50 years of age; so the opinions or experiences expressed may be more reflective of an older population. Of the non-ambulatory respondents, 83% used a manual chair and 17% used an electric wheelchair. Among semi-ambulatory respondents, 28% used a cane or crutches for assistance. Most respondents lived with family, and modifications were made in 69% of these homes to enhance independence in daily activities. Nearly half of the respondents were unsatisfied with their bathroom fixtures. Although there was a relatively wide range of responses depending upon the type of disability impairment of respondents, strong preferences (or dislikes) were noted for fixture designs.