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ISSN 1748-3107 print/ISSN 1748-3115 online
Disabil Rehabil Assist Technol, Early Online: 1–10
!2015 Informa UK Ltd. DOI: 10.3109/17483107.2015.1027295
RESEARCH PAPER
The impact of mobility assistive technology devices on participation for
individuals with disabilities
Jordan Carver, Ashley Ganus, Jon Mark Ivey, Teresa Plummer, and Ann Eubank
School of Occupational Therapy, Belmont University, Nashville, TN, USA
Abstract
Aim: This study aims to address the gap in research and contribute to the body of knowledge
on the perspectives assistive technology device users have toward their devices. Method: Mixed
methods were used to better understand the impact of mobility assistive technology devices
(MATDs) on participation for individuals with disabilities. The Functional Mobility Assessment
was administered in conjunction with two qualitative questions developed by the research
team allowing participants to expound on the impact of their MATD experience. Participants
were recruited online via the National Spinal Cord Injury Association website and in-person at
Abilities Expo in Atlanta, Georgia, and the International Seating Symposium in Nashville,
Tennessee. Results: Results are consistent with findings from prior research regarding
accessibility for individuals with disabilities. Corresponding findings were found in both the
quantitative and qualitative data and are categorized into several major themes: environment
(indoor and outdoor), surface heights, transportation, dependence, independence, quality of
life and participation. Conclusion: Quantitative data from this study indicate that users of MATD
are satisfied with the way in which their devices enable maneuvering indoors, while qualitative
data suggest otherwise. Implications for healthcare practitioners are described and future
recommendations are provided.
äImplications for Rehabilitation
Healthcare professionals should advocate for proper mobility assistive technology devices
(MATDs) for their patients in order to enable increased independence, safety and efficiency.
Healthcare professionals must be cognizant of the impact of the environment and/or
environmental barriers when prescribing MATD.
Additional areas of interest for future research may include investigating the impact of MATD
in association with date of onset of disability, according to diagnoses, or specific to length of
time since acquiring the device.
Keywords
Adults, assistive technology, experiences,
mobility, participation, unmet needs
History
Received 18 July 2014
Revised 3 January 2015
Accepted 05 March 2015
Published online 27 March 2015
Introduction
According to the 2012 Disability Status Report, 37.6 million
individuals in the USA have some level of disability with over 20
million individuals presenting with some ambulatory disability
[1]. Currently, there are about 3.6 million wheelchair users and
11.6 million persons requiring the use of a cane, crutches or
walker for mobility assistance in USA [2]. This is a startling
statistic as 2010 data indicated an estimated 2.8 million wheel-
chair users in the USA [3]. Thus, the number of persons with a
mobility-related disability that may require the use of assistive
technology (AT) is rapidly growing.
Mobility is defined as an ‘‘individual’s ability to move his or
her body within an environment or between environments and the
ability to manipulate objects’’ [9 p. 1]. Such abilities enable a
person to pursue life activities of his or her choosing. However,
impairments in body structures or functions can compromise a
person’s ability to perform tasks of daily living and community
socialization [4]. These impairments can occur following a
sudden traumatic accident such as a spinal cord injury or may
result from gradual progression of a disease like multiple
sclerosis. Individuals with less visible mobility impairments,
such as osteoarthritis of the knee or those with reduced standing
tolerance, may also experience mobility impairment and require
the use of AT.
The definition of AT most frequently cited in relevant
literature, and generally accepted internationally, is ‘‘any item,
piece of equipment, or product system, whether acquired com-
mercially off the shelf, modified, or customized, that is used to
increase, maintain, or improve functional capabilities of
Address for correspondence: Jordan Carver, School of Occupational
Therapy, Belmont University, 1900 Belmont Blvd., Nashville, TN 37212,
USA. Tel: +1 (615) 618-7870. E-mail: jordan.carver@pop.belmont.edu
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individuals with disabilities’’ [5, p. 5]. Mobility assistive technol-
ogy devices (MATD) include wheelchairs, walkers, canes,
crutches, gait trainers and scooters. These devices are designed
to enhance quality of life and provide important functional benefits
to assist the user while participating in activities of daily living [6].
Nevertheless, while the intended purpose for the device is
enhancement, assistive devices can be perceived to negatively
influence a person’s life [6]. Poorly fitted devices may result in
negative consequences to physical functioning, quality of life and
occupation [7,8]. A study by Jutai and Day [9] discovered that
owners of these devices sometimes neglect or fail to use the
functional technology while research by Kaye et al. [10] found
wheelchair users to have the highest level of activity and functional
limitation and the lowest level of employment when compared to
their counterparts. Functional and activity limitations can be
linked to economic and social oppression as individuals who do
not have access to technology are limited in their ability to gain
employment, maintain educational pursuits or engage in leisure
activities [11]. This existing research provides valuable insight
into important themes in AT.
Limited attention has been given in both past and current
research to assess the impact of MATD intervention on consumers
[6]. While the intended benefits of AT are well known among
caregivers, consumers, health professionals and policy-makers,
there is limited empirical evidence to justify the benefit and
efficacy of wheelchair provision [12,13]. The purpose of this
study is to understand how MATDs impact participation for
individuals with disabilities. The authors aim to address the gap in
research and contribute to the body of knowledge on the
perspectives AT device users have toward their MATDs.
Functional mobility is necessary to participate in activities of
daily living, leisure pursuits and community participation. It is
also a key component of independence for those with disabilities.
The Functional Mobility Assessment (FMA) instrument was used
to assess the attitudes of mobility device users toward their AT.
Kumar et al. [14] report that the FMA is a ‘‘reliable and stable
tool for assessing the functional performance of individuals who
use or need wheeled mobility and seating interventions’’ (p. 1)
thus endorsing the FMA as a useful tool to further explore the
effect of MATDs from the perspective of the user.
Literature review
There is a paucity of literature regarding the way in which AT
devices affect the consumer. The aim of this study is to explore
the ways in which consumers feel their MATDs are enabling their
participation and to identify barriers for participation. In a study
by Chaves et al. [6], the wheelchair is recognized as the most
important MATD used by persons with a disability, yet the one
that users most associate with barriers to participation. Similarly,
in this study, wheelchairs were cited as the most limiting factor,
not the disability or physical limitation.
Though many services are available to help individuals obtain
AT, limited attention has been given to how these devices actually
impact a person’s participation in everyday activities. A study by
Barker et al. [15] provides that due to large caseloads and
productivity requirements, there is often not enough time for
practitioners to discuss the impact that AT devices will have on
the individual, either physically or emotionally. Often patients are
rushed through the wheelchair selection process and are
prescribed seating systems or wheelchairs that the healthcare
provider deems as the ‘‘right fit’’. ‘‘Standard of care’’ is defined
by Hunt et al. [7] as ‘‘that which a reasonable and prudent
practitioner would do under the same or similar circumstances’’
(p. 1860). This study highlights problems that arise during a
wheelchair fitting due to neglected attention toward the users’
environment, as well as needs and preferences for wheelchair
design and features [7]. Barker et al. [15] also suggest that
although there has been significant research related to seating and
positioning, there is little research regarding patient sentiment
toward the addition of AT. Additionally, a study by Hoenig et al.
[16] suggests that although the marketplace for AT has grown
dramatically in the last 50 years, pertinent information ascertain-
ing the views of AT consumers is lacking. The authors provide:
‘‘Despite all of the advances in the technology itself and the large
sums of money being spent by consumers and third party payers
on assistive technology, we know remarkably little about the
actual use of assistive technology and the benefits from the
technology in the daily lives of the users’’ [16, p. 159].
This vital step in research related to AT is needed to determine
if a device is useful for consumers as they function in their homes
and communities, and if these devices actually promote inde-
pendence and mobility in their daily lives.
Participation for MATD users is often determined by many
intrinsic factors, such as wheelchair skills and physical capacity,
or external factors, such as environmental and social structures.
Chaves et al. [6] describe participation as ‘‘the extent of a
person’s involvement in life situations in relation to impairments,
activities, health condition, and contextual factors’’ (p. 1854).
Mobility limitations become critical as they affect an individual’s
ability to participate in all activities of daily living thus impacting
perception of life satisfaction. Chaves et al. [6] note that the
intent of AT is to enhance function and improve the independence
of the user; yet, these same devices, if perceived negatively by the
user, actually have the reverse effect. Little is revealed in current
research about how wheelchairs and related factors of physical
disability affect overall participation [6]. A 2011 study by de
Groot et al. [17] recognizes a strong relationship between
wheelchair users’ satisfaction and active lifestyle or participation.
Another important aspect in assessment is in the satisfaction of
the wheelchair user with the MATD. The study reveals that most
of the dissatisfaction voiced by consumers of wheeled mobility
devices was related to the slow, lengthy process of obtaining the
proper equipment [17].
Lutz and Bowers [18] point out two distinct philosophies
regarding the impact of AT devices on participation for individ-
uals with disabilities. First, disability is solely a medical issue and
should be handled as such, and second, disability is problematic at
the societal level due to societal discrimination and prejudice.
According to Kielhofner [19], rehabilitation professionals, when
guided by these dominant perspectives, end up doing ‘‘things that
disabled persons experience as unhelpful at best and harmful at
worst’’ (p. 487). Kim and Kyung [20] also reinforce the idea that
limitations to happiness and a meaningful life for those using AT
devices are not a result of physical restrictions but of the negative
connotation that society places on disability. Moreover, McMillen
and Soderberg [21] suggest that it is time to move beyond the
mere treatment of symptoms and improvement of physical
dysfunction to instead focus on the emotional issues surrounding
disability. The authors report that although AT devices have
helped improve quality of life for individuals with disabilities,
most participants in the study expressed that they often felt ‘‘in
the way’’ or were treated differently by members of society as a
result of the AT device [21]. Furthermore, Hoenig et al. [16]
provide that in order for AT to actually benefit the consumer, the
next step in AT research must move out of laboratory settings and
into the environment in which consumers typically use their
devices. It is vital that this take place in order to accurately
examine the daily life of AT consumers.
In his groundbreaking work Nothing About Us Without Us:
Disability,Oppression,and Empowerment, Charlton [22] explains
that consumers are giving voice to the preposterous nature of able
2J. Carver et al. Disabil Rehabil Assist Technol, Early Online: 1–10
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bodied persons making decisions for those who have a disabling
condition or a disability. The author states, ‘‘We are witnessing a
profound sea change among people with disabilities. For the first
time, a movement of people has emerged in every region of the
world which is demanding a recognition of their human rights and
their central role in determining those rights’’ [22, p. 9].
The World Health Organization’s (WHO) International
Classification of Functioning, Disability and Health (ICF) [23]
emphasizes what people do on a daily basis (i.e. performance) as
opposed to what they have the ability to do (i.e. capacity).
The Americans with Disabilities Act (ADA) was the nation’s
first comprehensive civil rights law that specifically addressed
the needs of people with disabilities. Passage of the ADA in
1990 provided a step forward in the inclusion and enforcement
of rights for individuals with disabilities. The ADA defines a
covered disability as a ‘‘physical or mental impairment that
substantially limits a major life activity’’ [5, p. 12] and
specifically prevents discrimination in employment, access to
public services, public accommodations and telecommunica-
tions. Although access to the environment has changed in
addition to protection of citizens through non-discriminatory
laws, not enough has been done to allow persons with
disabilities the access to the equipment they need.
According to Scherer [24] in her book Living in the State of
Stuck, advancement in AT has provided solutions for many
persons with disabilities to independently participate in activities
of daily living that they find relevant; however, the physical
freedom offered by many technical advances has not resulted in
the improved quality of life that many envisioned. Even with
numerous advances in technology, individuals often abandon or
discontinue use of their AT equipment. Scherer posits this is due
in part to a lack of a client-centered care and lack of focus on the
unique needs of each individual. Acknowledgment of the client’s
opinions, values and beliefs is an integral part in the selection of
AT equipment; however, it is unfortunately often overlooked.
Additionally, an empirical study by Scherer [25] notes that most
AT equipment is abandoned within the first year, often due to lack
of consumer input in device selection, or ‘‘whether or not the
device met consumer expectations for effectiveness, reliability,
durability, comfort, and ease of use’’ (p. 440). According to
current literature, there is evidence to support the need for the
consumers’ voice to be heard when choosing MATDs that affect
their overall participation, independence and mobility within the
community.
Methods
Researchers used the disability theory as an interpretive frame-
work throughout the study in order to gain insight regarding
perceived ease or difficulty of life participation in relation as it
related to MATD. Additionally, opportunistic areas in which
AT consumers have unmet needs were revealed. Belmont
University’s Institutional Review Board approved this study as
an exempt review.
The study, completed online via SurveyMonkey, included both
qualitative and quantitative measures to best understand partici-
pant views of participation in relation to his or her current means
of mobility. Participants were recruited from MATD users via
three venues: National Spinal Cord Injury Association (NSCIA)
website (phase I), Abilities Expo (phase II), and International
Seating Symposium (phase III). Venues were chosen based on
participant inclusion criteria and the large number of MATD users
in attendance. Inclusion criteria for all phases included: aged
18–100 years, individuals currently using MATD, and providing
informed consent. Sizeable age perimeters were used in order to
best represent MATD users across the lifespan.
The online survey commenced with two brief demographic
questions followed by the FMA, created by Mark Schmeler, PhD,
OTR/L, ATP, and his colleagues at the School of Health and
Rehabilitation Science at the University of Pittsburgh [26]. The
FMA provides a list of 10 questions regarding the ability of
current mobility to meet needs and desires [14]. Each question
was answered based on a Likert scale providing the following
options: completely agree, mostly agree, slightly agree, slightly
disagree, mostly disagree, completely disagree and does not apply
(Appendix A). Participants were invited to provide detailed
reasoning for any answer provided and additional commentary
was requested for questions answered ‘‘slightly disagree’’,
‘‘mostly disagree’’, or ‘‘completely disagree’’. After completion
of the FMA, participants were asked to respond to two open-
ended questions: ‘‘Are there any barriers to access that you
experience on a daily basis? If so, what are they?’’ and ‘‘What
impact has your current means of mobility had on your life?’’
(Appendix A). The accompanying questions were generated by
the researchers to supplement the FMA in expectation of
accurately examining the attitude of MATD users toward
everyday use of their equipment.
Though numerous assessment tools exist to assess functional
mobility [27,28,29], the FMA was specifically designed to
evaluate the impact of MATD on the user’s daily life. The FMA
is ‘‘a self-report outcome tool designed to measure the effective-
ness of wheeled mobility and seating (WMS) interventions for
persons with disabilities’’ [14, p. 1].
A study by Kumar et al. [14] assessed the test–retest reliability
of the FMA by inviting participants (n¼41) to complete a
primary questionnaire and duplicate questionnaire within 7 to 21
days of the original. WMS users comprised 51.2% of participants
(n¼21) with the remaining 48.8% (n¼20) being non-WMS who
were currently in the device acquisition process. Results of the
study provide satisfactory test–retest reliability scores (0.80) for
all items among WMS and non-WMS users. Therefore, the FMA’s
unique focus on measuring consumer approval and functional
variations related to MATD across the spectrum (manual
wheelchair, power wheelchair, scooter, walker and cane) allows
for a fitting and reliable assessment tool when considering the
lived experience of MATD users.
The accompanying questions were generated by the research-
ers to supplement the FMA in expectation of accurately
examining the attitude of MATD users toward everyday use of
their equipment. Experts in the field of AT were consulted during
development of the supplemental questions and recommendations
were incorporated in order to construct pertinent and appropriate
questions.
Participants
Phase I. A link was provided on the NSCIA research webpage
that led potential participants to the letter of invitation for the
research study. The letter included basic information regarding the
study and served as informed consent for each participant. After
reading the letter of invitation and agreeing to be a part of the
study, 10 participants (16.4%) were directed to SurveyMonkey, an
approved HIPAA compliant method of data collection, to
complete the online survey [30]. Participants (n¼10) completed
the survey via the NSCIA webpage of which 30% (n¼3) used
only a manual wheelchair, 20% (n¼2) used a cane, 20% (n¼2),
10% (n¼1) used only a power wheelchair, 10% (n¼1) used a
manual chair and a walker and 10% (n¼1) used a scooter, walker
and ambulated.
Phase II. In-person interviews were conducted at the Abilities
Expo in Atlanta, Georgia. Abilities Expo is an international
exposition held multiple times throughout the year to showcase
DOI: 10.3109/17483107.2015.1027295 Assistive technology and participation 3
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new technologies, solutions and opportunities for ability-enhan-
cing products and services for persons with disabilities, caregivers
and healthcare professionals [31]. Participants were recruited at
the Belmont University booth for 5–10-min interviews via
researchers and displayed letter of invitation. Upon agreeing to
the terms of the study and giving consent, participants completed
the online survey via SurveyMonkey (Appendix A) while seated
at the researchers’ booth. Forty-six individuals (75.4%) partici-
pated in the study during the three-day exhibition.
Phase III. In-person interviews were conducted at the inaug-
ural consumer day event at the 2013 International Seating
Symposium (ISS) in Nashville, Tennessee. ISS is an annual
event for advanced education in the areas of seating and mobility,
and serves healthcare professionals, medical equipment vendors,
disability institutes and mobility device users [32]. Similar to
phase II, participants were recruited for 5–10-min interviews
through a letter of invitation informing attendees of the study
design. All participants were informed on the details of the study
and provided consent for participation before completing the
online survey (Appendix A) at the researchers’ booth. Five
participants (8.2%) chose to participate in the study of which 40%
(n¼2) reported use of only a power wheelchair and 60% (n¼3)
reported use of only a manual wheelchair.
Findings
Data analysis
Analysis of the FMA questionnaire was completed using the
Pearson chi-square test to examine trends among MATD users
and daily interactions with their device. Because participants were
asked to indicate all MATD used, regardless of frequency of use, a
great number of possibilities existed when analyzing the data.
Therefore, researchers chose to classify responses based on the
following associations: participants who use both manual and
power wheelchairs and/or other devices, participants who use a
power wheelchair and/or other devices, participants who use a
manual wheelchair and/or other devices, and participants who
indicated using other MATD (i.e. walker, cane, crutch).
Ambulation was also represented as a choice in the ‘‘other’’
category. Participant answers were classified as follows: disagree,
slightly agree, mostly agree and completely agree (Table 1).
Finally, the supplemental question responses were examined using
QSR NVivo10. The researchers catalogd all answers to qualitative
questions and common themes were identified.
Quantitative data
Functional Mobility Assessment. Questions 1 and 2 of the
respondent survey asked participants to provide their age and
current means of mobility, signifying if more than one device
is utilized. MATD acknowledged in the study include: man-
ual wheelchairs, power wheelchairs, scooters, walkers, canes
and crutches. Furthermore, participants were asked to respond if
they are ambulatory in addition to using a mobility device.
Question 3 of the participant survey stated, ‘‘My current
means of mobility allows me to carry out my daily routine as
independently, safely, and efficiently as possible.’’ Respondents
answered as follows: 15% (9 of 60) disagreed that their current
means of mobility allowed them to carry out daily routines as
independently, safely and efficiently, as possible, 5% (3 of 60)
slightly agreed, 41.7% (25 of 60) mostly agreed and 38.3% (23 of
60) completely agreed. There was no statistically significant
difference among the types of mobility groups in terms of their
responses (X2
df¼9¼7.984, p¼0.536).
The next question added, ‘‘My currents means of mobility
meets my comfort needs (e.g. heat/moisture, sitting tolerance,
pain, stability). Of those surveyed, 16.4% disagreed (10 of 61),
13.1% slightly agreed (8 of 61), 36.1% mostly agreed (22 of 61)
and 34.4% completely agreed (21 of 61). While the majority of
responses to this question fell into the mostly agree/completely
agree category, the results from the Pearson chi-square test did not
provide a statistically significant value (X2
df¼9¼10.788,
p¼0.291). However, though no statistical significance exists,
there may be clinical significance in the results, as persons who
utilize both a manual and power wheelchair reported that their
current means of mobility met their comfort needs.
Question 5 of the survey stated: ‘‘My current means of
mobility meets my health needs. (e.g. pressure sores, breathing,
edema control, medical equipment).’’ Respondents answered as
follows: 13.3% (8 of 60) disagreed, 8.3% (5 of 60) slightly agreed,
while 35.0% (21 of 60) mostly agreed and 43.3% (26 of 60)
completely agreed. Although the collected data from this question
was not statistically significant (X2
df¼9¼6.487, p¼0.690) it is
clinically relevant in that 78.3% (47 of 60) of persons who use
manual and power wheelchairs and/or other devices users agreed
that their current means of mobility met health needs.
Question 6 of the survey provided ‘‘My current means of
mobility allows me to be as independent, safe and efficient as
possible.’’ Responses indicated that 13.1% (8 of 61) disagreed,
4.9% (3 of 61) slightly agreed, 44.3% (27 of 61) mostly agreed
and 37.7% (23 of 61) completely agreed. A statistically significant
relationship (X2
df¼9¼19.160, p¼0.024) was found between the
mode of transportation and independence by MATD users.
Question 7 of the participant survey asked for response to the
following: ‘‘My current means of mobility allows me to reach and
carry out tasks at different surface heights as independently,
safely, and efficiently as possible (e.g. table, counters, floors,
shelves).’’ Twenty-two percent (13 of 60) of respondents
answered that they disagreed, and 16.7% (10 of 60) slightly
agreed. Forty percent (24 of 60) of respondents mostly agreed,
and 21.7% (13 of 60) completely agreed. While the data show no
statistically significant relationship (X2
df¼9¼8.516, p¼0.483),
this information can be considered clinically relevant. Of
participants that utilize manual and power wheelchairs and/or
Table 1. Functional mobility assessment.
Questions Disagree Slightly agree Mostly agree Completely agree
Question 3: Daily routine (n¼60) 9 (15.0%) 3 (5.0%) 25 (41.7%) 23 (38.3%)
Question 4: Comfort needs (n¼61) 10 (16.4%) 8 (13.1%) 22 (36.1%) 21 (34.4%)
Question 5: Health needs (n¼60) 8 (13.3%) 5 (8.3%) 21 (35.0%) 26 (43.3%)
Question 6: Independence (n¼61) 8 (13.1%) 3 (4.9%) 27 (44.3%) 23 (37.7%)
Question 7: Surface heights (n¼60) 13 (22.0%) 10 (16.7%) 24 (40.0%) 13 (21.7%)
Question 8: Transfers (n¼54) 5 (9.3%) 2 (3.7%) 20 (37.0%) 27 (50.0%)
Question 9: Personal care tasks (n¼56) 3 (5.4%) 5 (8.9%) 20 (35.7%) 28 (50.0%)
Question 10: Indoor mobility (n¼58) 3 (5.2%) 2 (3.4%) 26 (44.8%) 27 (46.6%)
Question 11: Outdoor mobility (n¼61) 12 (19.7%) 11 (18.0%) 20 (32.8%) 18 (29.5%)
Question 12: Transportation (n¼59) 8 (13.6%) 10 (16.9%) 25 (42.4%) 16 (27.1%)
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other MATD, 50.0% (3 of 6) disagreed that their current means of
mobility allows them to reach and carry out tasks at different
surface heights with independence, safety and efficiency.
However, only 31.2% (5 of 16) of those that used only a power
wheelchair and/or other device and 11.1% (3 of 27) of those that
used only a manual wheelchair and/or other device disagreed that
access to differing surface heights is made more manageable with
their current means of mobility.
Question 8 stated, ‘‘My current means of mobility allows me
to transfer from one surface to another.’’ Responses were as
follows: 9.3% disagreed (5 of 54), 3.7% slightly agreed (2 of 54),
37.0% mostly agreed (20 of 54), and 50.0% completely agreed (27
of 54). The chi-square value (X2
df¼9¼12.332, p¼0.195) indicated
that there is not a significant relationship between mobility and an
individual’s ability to transfer from one surface to another.
Question 9 of the survey asked respondents if their current
means of mobility allowed them to carry out personal care tasks
(e.g. dressing, bowel/bladder care, eating, hygiene). Respondents
answered as follows: 5.4% (3 of 56) disagreed, 8.9% (5 of 56)
slightly agreed, 35.7% (20 of 56) mostly agreed and 50.0% (28 of
56) completely agreed. Although the data were not found to be
statistically significant (X2
df¼9¼7.239, p¼0.612), there is clinical
significance noted, as a total of 94.6% (53 of 56) of respondents
agreed that their MATD allowed them to carry out personal care
tasks. Among participants that used manual and power wheel-
chairs, 16.7% (1 of 6) disagreed that their current means of
mobility allowed them to carry out personal care tasks.
Conversely, only 7.1% (1 of 14) of those using power wheelchairs
and/or other devices disagreed and 0.0% (0 of 27) of participants
using manual wheelchairs and/or other devices disagreed.
Question 10 of the survey stated, ‘‘My current means of
mobility allows me to get around indoors (e.g. home, work, mall,
restaurants, ramps, obstacles).’’ Responses were as follows: 5.2%
disagreed (3 of 58), 3.4% slightly agreed (2 of 58), 44.8% (26 of
58) mostly agreed and 46.6% (27 of 58) completely agreed. A
statistically significant relationship (X2
df¼9¼17.114, p¼0.047)
was found among MATD users and their ability to get around
indoors.
Question 11 of the survey asked respondents to determine if
their current means of mobility allowed them to get around
outdoors. Respondents answered as follows: 19.7% disagreed (12
of 61), 18.0% (11 of 61) slightly agreed, 32.8% (20 of 61) mostly
agreed and 29.5% (18 of 61) completely agreed. There was no
statistically significant relationship between these variables
(X2
df¼9¼6.187, p¼0.721).
Finally, the survey asked participants to classify how their
current means of mobility allows for use of personal or public
transportation. Of all study participants, 13.6% (8 of 59) argued
against independence in transportation secondary to use of
MATD, while 16.9% (10 of 59) slightly agreed, 42.4% (25
of 59) mostly agreed and 27.1% (16 of 59) completely agreed
that their MATD allowed for independence, safety and efficiency
with transportation. Analysis of responses provided there is
no significant relationship (X2
df¼9¼10.110, p¼0.342) among
MATD users and their ability to access private or public
transportation independently, safely and efficiently. Interestingly,
of participants that utilize both manual and power wheelchairs
and/or other MATD, 99.9% (6 of 6) agreed that access to
transportation was made more manageable with their device,
while 80.0% (12 of 15) of those that used only a power wheelchair
and/or other device and 88.9% (24 of 27) of those that used only a
manual wheelchair and/or other device agreed that access to
transportation is manageable with their current means of mobility.
A statistically significant relationship was found among
responses to questions 6 and 10 of the respondent survey. The
findings from question 6, ‘‘My current means of mobility allows
me to be as independent, safe and efficient as possible’’, suggest
that there is a significant relationship between the mode of
transportation and the ability to complete activities that partici-
pants want and need to do throughout the day (X2
df¼9¼19.160,
p¼0.024). Participant responses to question 10, ‘‘My current
means of mobility allows me to get around indoors’’, also displays
a significant relationship (X2
df¼9¼17.114, p¼0.047). This
finding enables the researchers to conclude that there is a
meaningful relationship between the mode of transport used and
the capacity to maneuver indoors.
Qualitative data
Question 1: Barriers to access. Among participant responses to
question 1, ‘‘Are there any barriers to access that you experience
on a daily basis? If so, what are they?’’ the following themes
transpired: environment (indoor and outdoor), surface heights,
transportation, personal interactions and device acquisition.
Furthermore, many participants stated that no barriers exist on a
daily basis, while others note that everything is impacted.
Environment. Environmental access materialized as the pri-
mary barrier that participants experience on a daily basis. An
overwhelming majority of responses (72.74%) mentioned the
physical obstacles that exist in both indoor (38.21%) and outdoor
(34.53%) environments.
Indoor environment: The participants described the difficulties
that they face daily within public and private buildings. Though
access may be available to the building at large, the ability to
maneuver within the space was often deemed unreasonable or
even impossible when using MATD. Furthermore, participants
state that some buildings are simply not accessible. Responses
revealed that common indoor environment barriers include, but
are not limited to, doorways, restrooms, stairs, ramps and
historical buildings.
Doorways: Lack of adequate doorway width was often noted
for participants that utilize MATD. Noteworthy responses include
‘‘Doors are not wide enough to get into a building’’, ‘‘I cannot get
through narrow doorways’’, ‘‘Doors are not always wide enough
to allow for turns’’, ‘‘Heavy doors and narrow doorways’’, and
‘‘Getting through doorways, especially if [there are] not automatic
doors’’.
Restrooms: Similar to doorways, several participants noted
trouble in accessing restrooms secondary to narrow doorways or
inadequate space to maneuver the MATD in order to perform
necessary tasks. Showers were also mentioned as a barrier to
access experienced on a daily basis. One participant mentioned
that there are many ‘‘older buildings that still have inaccessible
areas, particularly restrooms’’, while another stated ‘‘going into
restroom[s] is a nightmare’’.
Stairs: Indoor environments that do not provide an alternative
to stairs prove challenging for those using mobility devices. Study
participants consistently noted stairs as indoor environmental
barriers to access.
Ramps: Ramp access, or lack of, is stated as another limiting
factor in accessing indoor environments. One participant noted
dependence on others in order to use ramps stating, ‘‘at times they
are not the right angle’’. Several participants also distinguished a
lack of ramps in indoor environments as an impediment.
Historical buildings: One of the more unique responses of
participants was the lack of access to historical buildings. ‘‘Some
places, especially in historic areas, are still not accessible’’, one
participant stated. Accessibility is found ‘‘only by stairs or curb,
so I am still excluded entrance.’’
Outdoor environment. Similar to accessing indoor environ-
ments, participants noted daily obstacles while navigating
outdoors. Over one-third (34.5%) of all responses regarding
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daily barriers to access mentioned difficulty with outdoor
environments. Among study participants, several common
responses regarding outdoor environment difficulties emerged:
uneven surfaces, curbs, sidewalks, ramps and stairs.
Uneven surfaces: Consistency of surface materials presented as
a major obstacle for study participants. One participant mentioned
‘‘grass, gravel and other outdoor surfaces’’ as a daily barrier,
while another mentions ‘‘grass, gravel, and uneven terrain’’.
Potholes and bad drainage were also noted as barriers.
Curbs: Curbs posed another level of difficulty when navigating
the outdoor environment. Although sidewalks, by law, are
supposed to be of a certain width and contain curb cuts, this is
often not the case. ‘‘Lack of curb cuts’’ posed difficulty for
several study participants.
Sidewalks: Lack of sidewalks or unkempt sidewalks presented
a challenge for participants as access to environments was denied
or made more problematic. Sidewalks with large cracks or bumps
prove difficult for MATD users.
Ramps: As with indoor environments, ramp access, or lack of,
was mentioned as a barrier for study participants. Ramps that are
not of appropriate grade or slope make access for persons using
mobility devices difficult. When no ramp is present, device users
may be required to access the environment by maneuvering their
MATD on a hill, which proves treacherous and unsafe.
Furthermore, similar to ramps, one participant stated that
‘‘steep driveways’’ are problematic when using mobility devices.
Stairs: Though not always considered, stairs were another
barrier frequently mentioned for MATD users in outdoor envir-
onments. As aforementioned, one participant noted that historical
sites are often accessed ‘‘only by stairs or curbs, so [the
participant is] still excluded entrance’’.
Surface heights. Study participants expressed difficulty when
encountering different surface heights in the environment. Shelves
in some stores were inaccessible, while the cabinets in the home
presented difficulties for other participants. One participant noted,
‘‘If things are not within reach, then access is difficult, even with
some mobility assistance.’’ Heights of restaurant tables were also
problematic for some participants, as table heights often did not
allow wheelchair users adequate space underneath the table,
leaving the MATD user unable to access the table. Nearly 7%
(6.26%) of the responses generated from this question referred to
difficulties that study participants encountered with surface
heights.
Personal interactions. The ability to have eye contact with
peers while conversing was noted by a single participant in the
study. Although this result indicated only a small percentage, of
the generated responses, the researchers felt that it was important
to mention as it directly pertains to the ability to participate in
daily communication. The participant noted that being in a
wheelchair meant that he/she was ‘‘usually not eye to eye with
people’’ which made interactions difficult. This is supported by
the RESNA position paper on the application of seat-elevating
devices for wheelchair users. The RESNA position on using seat-
elevators for wheelchairs states that during early developmental
stages ‘‘it is necessary to be at peer level for social and cognitive
development and to avoid learned helplessness’’ [33, p. 71].
Transportation. Of the surveyed MATD users, 3.99% of
responses indicated barriers to access related to transportation.
Participants reported difficult barriers when attempting to enter
and exit cars. Accessible parking was indicated as problematic due
to limited availability within the community. Study participants
noted an inadequate amount of accessible taxicabs for hire by those
traveling with the aid of mobility devices. Additionally, planes and
cruise lines were noted as being inaccessible. One participant
stated ‘‘getting on a plane is a nightmare ðcruise lines [are] not
accessible even though [located] in a handicapped room.’’
No daily impact. Interestingly, one-fourth of participant
responses (25%) deny interactions with barriers on a daily basis.
One participant stated, ‘‘It has gotten so much better’’ and no
longer encountered daily obstacles, while another mentions that
his/her current MATD is the reason for a lack of barriers.
Everything impacted. Additionally, four participant responses
(7.69%) noted that everything presents as a barrier to access
during daily routines. One participant noted ‘‘There are always
barriers; nothing is completely accessible’’, while another men-
tioned living in a ‘‘rural southern small town’’ and that the
barriers were ‘‘too many to mention’’.
Question 2: Impact on life. Investigation of participant
responses to question 2, ‘‘What impact has your device had on
your life?’’ resulted in the generation of the following themes:
environmental access (positive and negative), dependence, inde-
pendence, quality of life, overall participation (positive and
negative) and no impact.
Environmental access. Similar to responses generated when
analyzing daily barriers, participants mentioned the impact that
their MATD has had on accessing their surroundings. Of
participant responses, 28.12% mentioned the impact of environ-
mental access.
Positive. Some participants note the advantageous effects that
the MATD has made regarding access: ‘‘Gives me the ability to
leave my house and go places’’, ‘‘Gives access to my environ-
ment’’, ‘‘Helped me to get around better’’, ‘‘Makes it easier to
travel longer distances’’ and ‘‘My power assist chair is fantastic to
navigate stores and work out’’.
Negative. Unfortunately, others describe the difficulty that they
have faced since acquiring their device. Several participants cited
a lack of spontaneity in their lives stating, ‘‘I have to plan and
research where I go. I cannot go through gravel and outdoors to
the places I want to go unless I have my freewheel. I am limited
by the accessibility of a place’’ and ‘‘[It] somewhat limits places
we can go. [We] have to plan outings in advance’’. Another notes
how travel and socialization with family has been impacted
declaring, ‘‘It has made my life more limited travel wise ð
.customizable transport is expensive and also limited. I don’t
come home for school breaks because it is expensive’’.
Furthermore, one participant shares the influence of MATD on
employment: ‘‘[I] can no longer work. [I] use to go into people’s
homes and redecorate, but now feel like a liability in their
homesð[I] can no longer do activities in the rain. [It is] not worth
it because it takes too long to get ready with all of the
equipment’’.
Dependence. Of those surveyed, 5.57% responses reported that
MATDs make them dependent on others for assistance.
Specifically, ‘‘being slow’’ was mentioned more than once as a
characteristic factoring into the need for greater dependence. One
respondent stated, ‘‘It has slowed me down once I became ill. I
cry more now because at times I am unable to get things done on
my own.’’
Independence. Over one quarter of the study responses
(25.75%) were coded into the theme of independence.
Responses noted that the MATD enabled the individual the
ability to have more independence, gain access to his or her
environment and carry out activities of daily living. One
participant describes this by stating ‘‘it has allowed me to be as
independent as I can be and not have to bother people all the
time’’, while another said ‘‘due to strength issues, limited manual
mobility, the option of power or power assist was introduced to
my lifestyle and gave me greater independence and mobility while
post-op from rotator cuff injury’’.
Quality of life. Several participant responses (10.53%) noted
that their MATD has had a great impact on their quality of life.
When asked, ‘‘What impact has your device had on your life?’’
6J. Carver et al. Disabil Rehabil Assist Technol, Early Online: 1–10
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One participant responded, ‘‘Practically life or no life!’’ while
another mentioned ‘‘[I] haven’t let it stop me. I am passionate
about outdoor living sports, but have continued to do so [in my
wheelchair]. I make money doing what I love!’’ Other notable
responses include ‘‘I’ve had very few limits for years because of
my device; I can do almost anything with my chair – even climb a
mountain!’’ ‘‘It’s allowed me to get back into the world and enjoy
life’’, and ‘‘Great. [I am] able to live daily.’’ Finally, one study
participant mentions that the impact of the device has much to do
with the user’s perspective stating, ‘‘depends on how you cope
with it. If you accept your disability, you can do anything; if you
don’t accept it, everything is a barrier. It’s all in your mindset.’’
Overall participation
Positive. An increase in participation of daily activities was often
noted in participant responses (18.28%). One participant men-
tioned the ability to participate in higher education once acquiring
the appropriate MATD, while others affirm their ability to better
contribute to society once receiving their device. Still others note
the physical impact the device has made on their ability to
participate stating, ‘‘[It] helped me to get around better and helps
me feel more stable and like I’m not going to fall. [It has]
decreased the number of falls [and] even helps when exercising’’
and ‘‘[It] helps me retain energy longer’’. Finally, one participant
notes the social impact the device has made, testifying it has
helped him/her to ‘‘meet a lot of interesting people!’’
Negative. A slightly larger percentage of responses (18.42%)
reflect a decline in participation secondary to the MATD. One
participant mentioned, ‘‘Life has changed 180 degrees. [I am]
unable to go anywhere by [my]self though completely independ-
ent before. [My] wheelchair does not fit into the accessible van
correctly, severely limiting mobility.’’ Other participants also note
decline in participation due to transportation and time limitations
as their MATD ‘‘slows life down’’.
No impact. Seven percent of surveyed participant responses
indicated that MATDs have had no impact on their life,
designated by a reply of ‘‘none’’ to the question ‘‘What impact
has your device had on your life?’’
Discussion
Questions were asked of participants regarding satisfaction with
MATDs in relation to their participation and if the equipment met
their current mobility needs. Corresponding findings were found
in both the quantitative and qualitative data and are categorized
into several major themes: environment (indoor and outdoor),
surface heights, transportation, dependence, independence, qual-
ity of life and participation.
When asked to answer questions regarding ability of MATD to
carry out daily routines, meet health needs, increase independ-
ence, support completion of personal care tasks and manage
access to differing surface heights, participants that report using
both power and manual wheelchairs disagreed more often than all
other subgroups. Based on these findings, researchers speculate
that persons who use both power and manual wheelchairs may
have significant comorbidities that may require the use of multiple
MATDs.
Interestingly, quantitative data indicated that users of MATD
were satisfied with the way in which their devices enabled them to
maneuver indoors, while the qualitative portion of that question
suggested different results. Several participants distinguished a
lack of ramps in indoor environments as an impediment. Despite
the passage of ADA in 1990, participants inferred, according
to results of the quantitative and qualitative data, that the
environment is still not accessible. One user suggested difficulty
in ‘‘getting through doorways, especially if [there are] not
automatic doors’’. ‘‘Some places, especially in historic areas, are
still not accessible’’, one participant stated. Finally, according to
another participant, accessibility is found ‘‘only by stairs or curb,
so I am still excluded entrance’’.
Recommendations
In accord with outcomes of this study, the authors suggest that an
important consideration for healthcare professionals would be to
consider the impact of the environment or environmental barriers
when prescribing MATD. Additionally, clients should also receive
relevant information and education on the environmental impact
of their MATD. Practitioners may need to consider deeming home
and work assessments an essential part of the initial evaluation
process.
Findings from this study are consistent with findings from
prior research regarding accessibility for individuals with
disabilities. In a 1993 report by the United Nations, it was
inferred that according to international policy and guidelines,
all housing should be accessible for all people [34].
Unfortunately, this is not the case. Time and again, research
and practice have proven that home modifications are an asset
for individuals’ ability to ‘‘manage chronic health conditions,
increase independence, safety, ease of use, security, self-esteem,
[and] self-confidence’’ [35, p. 44]. Home modifications may
include adding adaptive hardware and using assistive technol-
ogies as interventions to aid in managing poor health condi-
tions, maintaining or improving function, ensuring safety and
helping minimize health care costs [35]. Unfortunately, home
modifications are difficult to obtain in many areas of the
country. This limitation is not due to a lack of providers (e.g.
carpenters, remodelers, contractors) but a lack of specialists
who are knowledgeable in pertinent environmental factors and
functional abilities of the individual for whom renovations are
completed [35].
Implications for healthcare practitioners
Healthcare practitioners using the person–environment–
occupation model view occupational performance as a combin-
ation of the intersection of the person, environment and occupa-
tion [36]. Interventions utilizing this framework incorporate a
client-centered approach with equal emphasis given to both the
environment and occupation. Healthcare professionals may
choose to pursue specialized training to conduct accurate home
assessments and prescribe appropriate modifications in order to
address all aspects affecting a person’s quality of life and
independence [35].
According to the quantitative data, a majority of respondents
indicated that their current means of mobility enabled them to be
as independent, safe and efficient as possible. Researchers
theorize that this finding suggests the use of MATDs create a
sense of independence; thus, empowering users of MATD.
Comments such as, ‘‘it has allowed me to be as independent as
I can be and not have to bother people all the time’’ and ‘‘the
option of power or power assist was introduced to my lifestyle and
gave me greater independence and mobility’’ validate this shared
sentiment among users.
Limitations
Probable limitations of this study include the sample size, number
of data collection sites, geographic location, and number of
respondents with recent injuries. The small sample size limits the
generalizability of the results; however, the study sample was
extracted from a cohort of MATD users. There is a need for future
studies with a larger population size of those who use MATDs.
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Moreover, a larger sample population would allow a more
encompassing examination of MATD users’ perspectives.
Data collection utilized two physical sites and one online
location. Given more time, researchers would have expanded the
number of physical data collection sites as well as extended the
period of time the online survey remained ‘‘live’’. Finally,
marketing of the online data collection survey was limited to the
National Spinal Cord Injury Association’s website. Future
researchers may benefit from extending the website offerings to
reach a broader base of MATD users.
The geographic location of the physical data collection sites
was the southeast portion of the USA – specifically Atlanta,
Georgia, and Nashville, Tennessee. These events attracted a range
of individuals from the surrounding areas but were not a
representative sample of the broader population of USA MATD
users. Additionally, due to the close proximity of the Shepard
Center to the Atlanta, Georgia, exposition, many of the survey
respondents were newly injured with perspectives that may vary
greatly from individuals who have been using MATDs for a
longer period of time. Although the findings from this study
revealed important areas in relation to MATD, it may not be
representative of other populations of mobility device users.
Furthermore, it may also prove difficult to properly analyze data
from a mixed methods research study and correctly interpret and
integrate the findings.
Future research recommendations
Additional areas of interest for future research may include
investigating the impact of MATD in association with date of
onset of disability, according to diagnoses, or specific to length of
time since acquiring the device. Moreover, assessing specific age
ranges related to different types of MATD or levels of reported
independence according to age may prove useful. Future research
may also want to explore if differences are observed among single
MATD users versus multiple MATD users. Further specification
of the indoor environment being used by the AT consumer may
also prove advantageous in future studies. For example, is the
MATD used in a work environment or a home environment, or in
a publicly accessible property or a private home? Finally, future
studies may include supplemental questions regarding consumer
satisfaction in order to best understand the impact of MATD from
the perspective of the user.
Conclusion
The purpose of this study was to expose and explore the
implications of MATDs on the users’ perception of life partici-
pation. It is important to look beyond the actual MATD and
instead focus on factors influencing the interaction between a
person with a disability and their environment. If rehabilitation is
to succeed, with users of MATD receiving the full benefits of
their devices, interventions must concentrate on reducing the gap
between what a person wants or needs to do and what they
actually do, subsequent to a life long disability or a sudden onset
disability or injury. One participant eloquently stated the positive
effect that MATD has had on his/her life: ‘‘Having a properly
configured wheelchair allows me to be an active, independent
member of my community. Any investment in mobility pays
dividends in employment, use of discretionary income, and lower
caregiver burden.’’
Declaration of interest
The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of this article.
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Appendix A
Subject Code: _______
Functional Mobility Assessment (FMA)
DIRECTIONS:
Step 1. Please answer the following 10 questions by placing an ‘X’ in the box under the response (completely agree, mostly agree, slightly agree, etc.) that best
matches your ability to function while in your current means of mobility (i.e., walking, cane, crutch, walker, manual wheelchair, power wheelchair or scooter). All
examples may not apply to you, and there may be tasks you perform that are not listed. Mark each question only one time. If you answer, *slightly, *mostly, or
*completely disagree for any question, please write and specify the reason for your disagreement in the Comments section.
Step 2. Please determine your priorities, by rating the importance of the content in each of the 10 questions in the shaded box to the right of each question. Rate
your highest priority as 10, and your lowest priority as 1.
What is your current means of mobility device?
(Check all that apply)
Walking______ Walker______ Cane______ Crutch______
Manual Wheelchair______ Power Wheelchair______ Scooter______
1. My current means of mobility allows me to carry out my
daily routine as independently, safely and efficiently as
possible:
(e.g., tasks I want to do, need to do, am required to do-when
and where needed)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Rating
priority
Comments:
2. My current means of mobility meets my comfort needs:
(e.g., heat/moisture, sitting tolerance, pain, stability)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Comments:
3. My current means of mobility meets my health needs:
(e.g., pressure sores, breathing, edema control, medical
equipment)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Comments:
4. My current means of mobility allows me to be as
independent, safe and efficientas possible:
(e.g., do what I want it to do when and where I want to do it)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Comments:
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Subject Code: _______
5. My current means of mobility allows me to reach and carry
out tasks at different surface heights as independently,
safely and efficiently as possible:
(e.g., table, counters, floors, shelves)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Comments:
6. My current means of mobility allows me to transfer from
one surface to another:
(e.g., bed, toilet, chair)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Comments:
7. My current means of mobility allows me to carry out
personal care tasks:
(e.g., dressing, bowel/bladder care, eating, hygiene)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Comments:
8. My current means of mobility allows me to get around
indoors:
(e.g., home, work, mall, restaurants, ramps, obstacles)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completely
Disagree
Does not
apply
Comments:
9. My current means of mobility allows me to get around
outdoors:
(e.g., uneven surfaces, dirt, grass, gravel, ramps, obstacles)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completel
y Disagree
Does not
apply
Comments:
10. My current means of mobility allows me to use personal or
public transportation as independently, safely and
efficiently as possible:
(e.g., secure, stow, ride)
Completely
Agree
Mostly
Agree
Slightly
Agree
*Slightly
Disagree
*Mostly
Disagree
*Completel
y Disagree
Does not
apply
Comments:
Qualitative Questions
Project Title: The impact of mobility assistive technology devices on participation for individuals with disabilities
(1) Are there barriers to access that you experience on a daily basis? If so, what are they?
(2) What impact has your current means of mobility had on your life?
10 J. Carver et al. Disabil Rehabil Assist Technol, Early Online: 1–10
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