Study Profile:
Naomi Gefen
Occupational Therapist
ALYN Hospital, Jerusalem, Israel
naomi@alyn.org
Naomi Gefen is an occupational therapist and the Deputy Director General of ALYN Hospital Pediatric and Adolescent Rehabilitation Center in Jerusalem, Israel. Naomi has 27 years of experience in assistive technology and medical devices. She holds a BA and MSc in Occupational Therapy from Hebrew University and a Master’s Degree in Public Administration from the Harvard Kennedy School as a Wexner Israel Fellow (2008). Naomi specializes in assistive technology for children with disabilities and works together with the Ministry of Health to improve services for children with disabilities. She is a doctoral candidate at Haifa University, modifying and testing a simulator for powered wheelchairs for children with severe disabilities.
Clinical research profile:
A modified version of the McGill Immersive Wheelchair Simulator (MiWe-C) is being used at ALYN Hospital is Jerusalem Israel. The original MiWe was developed by Dr. Philippe Archambault’s team at McGill University in Montreal and used for practice with adults learning powered mobility skills (https://atrehab.ca/) . The modified version was translated into Hebrew, additional environments were added for research needs and children avatars were added.
Where is the research being done?
The research is being performed at ALYN Hospital, a Pediatric and Adolescent Rehabilitation Center in Jerusalem, Israel. ALYN Hospital treats children with congenital and acquired physical disabilities from birth to adulthood where 300 children are seen daily. ALYN uses technology and assistive devices to facilitate independent function. The ALYN Equipment Display Center enables children and families access to different equipment to try out and decide what would best suit their children’s’ needs. As part of the center, ALYN has a lending program of powered wheelchairs for children to practice at home to become proficient drivers, and entitled for funding of their own powered wheelchair from the Israel Ministry of Health. In addition to determining the benefits of simulator training compared to convention modes, this program has been helpful in reducing the waiting list for lending chairs.
How is the MiWe-C being used in research?
The original research on the MiWe was performed on healthy adults for feasibility, and adults with physical disabilities that were proficient in their driving skills for validity and reliability1.
The first study at ALYN hospital assessed the validity of the MiWe-C2. Thirty proficient powered wheelchair drivers aged 5-18 years with physical disabilities were assessed by driving their own chair through a physical route in ALYN Hospital and by then driving the same virtual route via the MiWe-C. Their performance was compared using the Powered Mobility Program3. The scores for the total PMP score as rated during both simulator wheelchair driving and during physical driving were very high (M=4.90, SD=0.20; M=4.96, SD=0.12, respectively) with no significant difference between them (z= -1.69, p=0.09). Results showed that the MiWe-C was valid to use with children.
A second study, currently ongoing, is a single-center quasi randomized controlled intervention study, that compares the learning process of powered mobility of 40 children with physical disabilities over a period of three months. The control group practices powered mobility on a real chair whereas the experimental group practiced powered mobility via the MiWe-C simulator. To date, 27 children have completed the study.
What benefits do you gain by using this system?
Powered mobility is a skill that children need to learn since it is unsafe for the children and others in the environment until proficiency is obtained4. To become a proficient driver, intense practice time is needed but practice depends on having a chair to practice with and a staff or family member available to support the practice. Having a feasible and effective alternative to practice powered mobility skills in a safe manner is thus beneficial for all involved.
The MiWe-C provides a viable opportunity for children to practice sitting safely in front of the computer. Children can train specific skills that might need additional practice time (e.g. maneuvering a door). An additional advantage is the price; a powered wheelchair costs $2000-$8000 with an average of $4000. The simulator program is free for download (with permission from Dr. Archambault) and is suitable for use on any home computer (desktop or laptop). The only cost is the adapted joystick, made from a Logitech Extreme 3D Pro and a Penny and Giles J200 (~$260).
What were your challenges in using the MiWe-C system?
The MiWe was adapted for use in Israel by translating the user interface and by adding two customized routes for research purposes. The modification of the program required working with Canadian company Illogika. Since the Hebrew language is written from right to left, there were technical challenges in adapting the English/French interface. In addition, the simulation program is only suitable to use with a joystick. This eliminated the option for children that use switches or a scanner to drive a powered wheelchair.
(See full article in the ISVR Newsletter Issue 17)
References
1. Archambault, P. S., Tremblay, S., Cachecho, S., Routhier, F., & Boissy, P. (2012). Driving performance in a power wheelchair simulator. Disability and Rehabilitation: Assistive Technology, 7(3), 226-233.
2. Gefen, N., Rigbi, A., Archambault, P. S., & Weiss, P. L. (2019). Comparing children’s driving abilities in physical and virtual environments. Disability and Rehabilitation: Assistive Technology, 1-8.
3. Furumasu, J., Guerette, P., & Tefft, D. (1996). The development of a powered wheelchair mobility program for young children. Technology and Disability, 5(1), 41-48.
4. Gefen, N., Rigbi, A., & Weiss, P. L. (2019). Predictive model of proficiency in powered mobility of children and young adults with motor impairments. Developmental Medicine & Child Neurology, 61(12), 1416-1422.
