Recommendations on Standards for the Design of Medical Diagnostic Equipment for Adults with Disabilities, Advisory Committee Final Report

3.3 Data Sources

As noted above, MDE Advisory Committee utilized their own expertise in deliberations about accessibility standard specifications. Early on, it became clear that some Committee members were unfamiliar with issues raised during transfers from a wheelchair or scooter onto a surface such as an examination table. To educate their colleagues, several Committee members shared videos from their own research or organizations to provide general experiential information about transfers. In addition, Committee members who use wheelchairs or scooters sometimes raised considerations from their personal experiences obtaining health care services.

The Committee also aimed to support their recommendations with as much scientific evidence as possible. In instances where data were either missing or inconclusive, they sought additional expert opinion. As appropriate and relevant, the Committee also aimed to make their recommendations consistent with previous guidelines and standards set by the U.S. Access Board and made enforceable by the U.S. Department of Justice’s issuance of regulations comprising the guidelines or standards. Access Board staff and some Committee members brought pertinent existing accessibility standards, such as the 2010 ADA Standards for Accessible Design, to the attention of the full Committee. The subsections below describe specific sources of information used by the Committee.

3.3.1 Research Data

MDE Advisory Committee members worked with U.S. Access Board staff to find as many studies as possible that were relevant to various accessibility standards. They relied most heavily upon the work of the Center for Inclusive Design and Environmental Access (IDeA) at the State University of New York at Buffalo, which had conducted the Anthropometry of Wheeled Mobility (AWM) Project. This anthropometric study of 500 persons who use wheeled mobility devices (WMD) involved collection of demographic data, information on WMD characteristics, and structural and functional anthropometry measures. To inform the MDE Advisory Committee, U.S. Access Board staff asked Clive D’Souza and Edward Steinfeld to reanalyze the AWM Project data to examine the adequacy of proposed transfer surface dimensions (30” x 15”) as a static seating surface. Dr. Steinfeld presented their findings at the Committee’s second meeting, and he made himself available to answer Committee and Subcommittee (Examination Tables and Chairs) questions over subsequent months. As mentioned in descriptions of the rationale for various standard recommendations, the Committee found the IDeA data to be very helpful. However, as noted by Dr. Steinfeld, a limitation for the Committee’s purpose was that the AWM Project evaluated only static measures (i.e., persons seated in WMD) rather than examining the active process of transferring from a WMD to another surface, the focus of the Committee’s recommendations.

The Committee also considered findings from University of Pittsburgh study that looked at transfers, specifically at how different conditions affected the abilities of WMD users to transfer from their WMD to another surface. (This study, “The Impact of Transfer Setup on the Performance of Independent Transfers: Final Report,” from the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, University of Pittsburgh, had been presented at the US Access Board meeting in Washington, DC on July 11, 2011.) University of Pittsburgh investigators have strong collaborations with Department of Veterans Affairs health care providers and groups affiliated with paralyzed veterans’ organizations, so not surprisingly 88 study subjects were men and 24 were women; 54 had spinal cord injuries (another 4 had spinal cord injury plus another condition). Thus, the study subjects do not reflect the general population of persons who use WMD. Nevertheless, the research provided useful insights about how various features of the transfer setting, including gaps between the transfer surface and the WMD, differences in height, and availability and positioning of supports, affect the ability of WMD users to transfer.

For additional guidance, some Committee members referred occasionally to: The Measure of Man and Woman: Human Factors in Design, Revised Edition, Alvin R. Tilley (Henry Dreyfuss Associates), Wiley (John Wiley & Sons, Inc.) 2001; and The Rules of Work: A Practical Engineering Guide to Ergonomics, Second Edition, Dan MacLeod, CRC Press, 2002.

3.3.2 Experienced Clinicians

Although the studies offered helpful data, the Committee felt strongly that it would be useful to hear perspectives from clinicians with extensive experience with persons with disabilities about the process of transferring patients from wheelchairs or scooters onto medical equipment. In response, U.S. Access Board staff invited seven clinicians to make presentations at the Committee’s third meeting. Table 3.3.2 lists the names, clinical disciplines, and affiliations of these experienced clinicians.

Table 3.3.2

Clinicians Who Presented to the MDE Advisory Committee

At the Committee’s request, U.S. Access Board staff asked these clinicians to comment on topics primarily related to transferring patients and the implications for recommendations relating to transfer surfaces. The following request was sent to the clinical speakers to formulate their comments to the Committee:^X

• Committee members want to learn about common transfer methods, including information about mobility device positioning, transfer techniques, and transfer aids.

• Committee members are deliberating how wide the portion of an exam table surface onto which patients transfer must be (defined as a “transfer surface”). The Committee is considering two main options: minimum widths of 28” or 30”. “Tables” are equipment used by patients in supine, prone, or side-lying positions.

• Committee members are considering the same transfer width issue for exam chairs. Because exam chairs have up-right back support, armrests, and patients do not typically need to reposition their entire body once on the equipment, a narrower minimum width of 21” is proposed. Committee members are deliberating whether this width requirement should be the same as or less than table type equipment discussed above (28” or 30”).

• The Committee has agreed that transfer surfaces (for both tables and chairs) should be adjustable in height and is now determining the height ranges that must be provided. Committee members are considering two low height options: 17” or 19”. Competing concerns involve not excluding patients in wheelchairs with low seat heights and equipment features/mechanisms that would be difficult or costly to position underneath an exam surface height of less than 19”.

• Committee members will shortly consider what kind of supports (handholds, rails, etc.) tables and chairs should have to facilitate transfers and whether these supports should be positioned at particular locations on/around the exam surface. These deliberations will include discussions about the position (horizontal, angled, or vertical), length, gripping shape, and distance above and from the transfer surface.

The clinicians’ presentations were timed so that Committee members would have ample chance to ask them questions. As noted in Sections 5 and 6, the opinions of these experienced clinicians figured prominently in some Committee recommendations. An obvious limitation of their contributions is the relatively small number of clinicians and lack of representation from a full range of clinical disciplines.

Notes

^X The text below is what was sent to the clinician speakers. Please note that the language (e.g., about the two low options for transfer surface height) reflects the Advisory Committee’s activities and thinking at the time of the request to the clinician speakers.

3.3.3 Presentations about MDE Types

Committee members representing two stakeholder groups – manufacturers of imaging equipment and examination tables and chairs – requested the opportunity to make presentations before the Committee. The imaging presentation occurred at the third meeting and the presentations about examination tables and chairs at the fourth meeting (Table 3.3.3). Both sets of presentations highlighted technological considerations specific to these broad categories of MDE. This material is described further in Section 4.3 (imaging equipment) and Section 4.1 (tables and chairs). Committee members had ample time to ask questions and discuss the implications of the issues presented for making the accessibility standard recommendations.

Table 3.3.3

Manufacturing and Engineering Representatives
Who Presented to the MDE Advisory Committee

 Notes

^Y MITA is the Medical Imaging & Technology Alliance, a division of the National Electrical Manufacturers Association