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50 Years of Inclusive Design for Childhood Mobility; Insights from an Illustrative Mapping Review
Abstract and Figures
In recent years, the field of Inclusive Paediatric Mobility (IPM) has gained increasing interest from a variety of disciplines and stakeholders, including designers and engineers, healthcare professionals, policymakers, children and families. This has led to increased visibility and understanding, as well as the development of new products and services. However, knowledge around IPM design remains fragmented and with many issues around the desirability, feasibility, and viability of interventions. This is the first illustrative mapping review of the IPM design field to capture, classify, and analyse IPM design contributions chronologically over the past five decades. The review explores relationships between contributions, their context, and their significance in the landscape of IPM at the time. This paper outlines insights from the mapping review and highlights key trends, gaps, and issues in the IPM design field since 1970. Key themes and considerations are proposed for a framework to improve the future of IPM design.
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... Inclusive design is a field in need of such a review as there are currently very little critically reflective accounts of its origin, evolution and history. An illustrative review of literature has revealed that in fact there appears to be only one academic paper dedicated to the History of Inclusive Design within the UK (Coleman, 2013) and other accounts look only at the evolution of a specific field such as inclusive paediatric mobility design (O'Sullivan and Nickpour, 2020), specific design object (Pullin,2007) or focus on contemporary history only. The lack of diversity in perspectives, critical reflections, and reviews of the field as a whole, highlights an urgent necessity for a critically reflective review of the history and evolution of Inclusive Design as a fieldboth conceptually and in practice. ...
This paper sets out to-for the first time-critically review the history of Inclusive Design on two distinct levels, i.e. the narratives that shape it and the historical milestones which contribute to its evolution. Through an illustrative review of literature and object ethnography, two sets of timelines are outlined. First, a milestone timeline helps establish the chronological evolution of Inclusive Design based on historical milestones and sociocultural perspectives. Second, a narrative timeline helps uncover the underlying narratives around matters of disability, design and inclusivity, and how they evolved. This first timeline review of narratives and milestones; a) identifies historical and emerging shifts in direction and mentality; b) offers granular as well as holistic views; and c) poses major questions onto Inclusive Design as a field in need of more critically reflective approaches-both conceptually and in practice.
... Beyond interventions, design also offers methodologies, theories and empirical contributions. 40 For example, HCD principles, or co-design methods, can be applied to oral healthcare research. ...
Challenges and trends such as person-centred care, demographic shifts, and technological advancements are transforming modern oral health systems. Inclusive design and human-centred design are disciplines highly relevant and potentially instrumental to these oral healthcare transformations. This paper provides an overview of the definitions and characteristics of inclusive and human-centred design, which centre on understanding people’s multifaceted needs, expectations, behaviours and relationships, and engaging with diverse and often excluded populations. Design’s broad capabilities are outlined across outcome and contribution types, and the potential role of inclusive and human-centred design to oral health is explored by outlining its relevance to key transformational, societal and technological shifts. Finally, barriers and drivers to the adoption of inclusive and human-centred design in oral health are discussed around three themes; awareness and understanding of the role and value of design; disciplinary differences; and the wider healthcare systems context.
... Downsizing adult mobility designs to fit children has historically resulted in various issues around the desirability and feasibility of IPM interventions such as wheelchairs [28]. Some of the technical and objective requirements in IPM design can be addressed through engineering and clinical analyses, whereas subjective requirements necessitate input from children. ...
This paper considers the possibilities of analysing children’s own designs to contribute to the design of inclusive paediatric mobility interventions. The aim of this paper is threefold: (1) to develop a framework for child-centred design analysis, (2) to analyse children’s designs to explore both quantitative and qualitative insights and (3) to explore how children’s voice could be elevated through design research.
A Child-centred Design Analysis Framework is developed in an interdisciplinary manner, comprising four dimensions including Child, Content, Context and Format. It is used as a vehicle to analyse and code 130 ‘Dream Wheelchair’ designs by children.
The children’s ‘Dream Wheelchair’ designs reference a range of features and priorities, which are gathered into themes through the framework, providing insights into children’s individual and collective mobility narratives, values and requirements. Themes are explored through a qualitative interdisciplinary lens to understand the nature of children’s lived experiences.
The framework promotes child-centred framing through extracting meaning from children’s own designs. It is suggested that child-centred framing and a rights-respecting approach to assistive technology design research can lead to more appropriate design outcomes and improved user experiences for children with disabilities.
Objectives:
There is increasing recognition of the value and capabilities of design in healthcare. Beyond the development of medical devices, design is increasingly being applied to intangible, complex and systemic healthcare problems. However, there is limited evidence on the use of design specifically in the field of oral health. This systematic mapping study aims to collate and catalogue evidence of design in oral health.
Methods:
A systematic search of academic databases and grey literature was performed. Duplicate results were removed, and publications relating to the same project were grouped. Reviewers from design and oral health independently screened a sample of the dataset. Projects of both relevance to oral health, and with input from a designer or clear implementation of a design methodology or approach were included. Projects were coded and plotted on a novel interactive evidence map.
Results:
119 design and oral health projects were included between 1973 and 2022. Interventional (n = 94, 79%), empirical (n = 46, 39%), methodological (n = 35, 29%) and theoretical (n = 7, 6%) design contributions were identified across the projects. The projects were categorized by four orders of design: first-graphics (n = 6, 5%), second-products (n = 41, 34%), third-interactions (n = 70, 59%), and fourth-systems (n = 2, 2%). Design was found in a diverse range of contexts in oral health; most commonly being relevant to general patients (n = 61, 51%), and for use in general dental practice (n = 56, 47%). Further design outcome categories (digital material; printed material; object; room or space; apparel; process; smart device; tangible interface; graphical interface; virtual reality; service; policy; system) and oral health themes (oral health literacy; oral care training; dental clinic design; dental instruments and equipment; personal oral care; dental appliance; clinician health and productivity; clinical information systems; informed consent; oral health promotion and prevention; oral care training; patient interactions and experience) were identified.
Conclusions:
The novel interactive evidence map of design in oral health created enables ongoing and open-ended multivariant documentation and analysis of the evidence, as well as identification of strategic opportunities. Future research and policy implications include; recognition and engagement with the full capabilities of design; integration of design experts; fostering inclusive engagement and collaboration; disentangling patient and public involvement; advancing human-centred systems approaches; adopting design-led approaches for policy-making.
Inclusive Design and Human-Centred Design are increasingly applied to
health and healthcare systems. However, there is limited evidence of the utilisation
and understanding of these approaches specifically in oral healthcare. This paper
reviews the state of Inclusive and Human-Centred Design in oral healthcare. A
systematic map of 104 design in oral healthcare is screened to identify 50 projects of
explicit and implicit relevance to Inclusive Design and/or Human-Centred Design. The
projects are analysed to examine the nature of Inclusive and Human-Centred Design
in oral healthcare; reflect on who is being designed for and with; and assess the
balance of outcomes and contributions being produced. The review reveals limited
recognition and awareness of both Inclusive and Human-Centred Design in oral
healthcare and highlights significant inconsistencies in design communication and
application. Strategic observations include expanding interventions across the four
orders of design; increasing theory development; and advancing approaches to public
engagement.
The design of inclusive paediatric mobility (IPM) interventions, such as children's wheelchairs, are entangled with technological, health and social considerations. As narratives around childhood, disability and mobility shift and transform, these entanglements evolve. In order to optimise the experience of childhood mobility, IPM designers must understand and respond to such changes and channel children's own requirements, desires and 'dreams' into the design process; this can be achieved by utilising a child-centred design approach. This paper identifies meaningful child-centred IPM design insights and opportunities through the interdisciplinary analysis of 130 dream wheelchair designs by disabled children, aged 4 to 17 years. A novel interdisciplinary and child-centred design analysis framework is developed to dissect, categorise and code the topics and features expressed through visuals and written descriptions in each of the children's dream wheelchair designs. Children's mobility narratives, desires and requirements are elicited and trending topics are discussed. It is proposed that valuing children's voices in the IPM design process could alter both the process of designing IPM interventions as well as the product outcomes.
The design of inclusive paediatric mobility (IPM) interventions, such as children's wheelchairs, are entangled with technological, health and social considerations. As narratives around childhood, disability and mobility shift and transform, these entanglements evolve. In order to optimise the experience of childhood mobility, IPM designers must understand and respond to such changes and channel children's own requirements, desires and 'dreams' into the design process; this can be achieved by utilising a child-centred design approach. This paper identifies meaningful child-centred IPM design insights and opportunities through the interdisciplinary analysis of 130 dream wheelchair designs by disabled children, aged 4 to 17 years. A novel interdisciplinary and child-centred design analysis framework is developed to dissect, categorise and code the topics and features expressed through visuals and written descriptions in each of the children's dream wheelchair designs. Children's mobility narratives, desires and requirements are elicited and trending topics are discussed. It is proposed that valuing children's voices in the IPM design process could alter both the process of designing IPM interventions as well as the product outcomes.
Inclusive paediatric mobility (IPM) design is a growing field in need of critical and foundational designerly transitions in order to better deal with a wicked problem. This article adopts an illustrative mapping review method to interrogate the past 50 years of IPM design, aiming to identify alternative designerly ways that could help transition the field towards a more desirable long-term future. IPM Design contributions between 1970 and 2020 are mapped chronologically across Theoretical, Methodological, Empirical, and Interventional categories. A Reflection-for-Transition framework of Designerly Ways is developed to identify existing and alternative designerly ways, through categorising key insights from the mapping review. The framework consists of five interrelated dimensions, including Designerly: Investigations, Processes, Contributions, Collaborations, and Contexts. Proposed alternative designerly ways include: exploring high-level narratives and social imaginaries; shifting focus towards problem-framing, child-centred design and transdisciplinarity; improved documentation and sharing to build a body of knowledge; and exploring extended design contexts.
Inclusive Paediatric Mobility (IPM) design is the application of an inclusive design process to create mobility interventions such as wheelchairs, walking aids and exoskeletons, with the fundamental goal of optimising the experience of childhood. The field of IPM has experienced growing attention from a wide range of disciplines and stakeholders, resulting in increased knowledge and the development of new interventions. However, there remains a myriad of issues around the viability, feasibility, and desirability of paediatric mobility products and services, as well as poor documentation of the successes, failures, and approaches used within the field. This paper maps out the history of the field across four categories of contributions i.e. Interventional, Theoretical, Methodological, and Empirical. Key drivers for change identified through the mapping review include Documentation and Representation, Design Approach, Interdisciplinarity, Regionality, and Operational and Market characteristics. These findings offer a starting point for reimagining the future of IPM design.
There is an interesting and long history of prostheses designed for those with upper-limb difference, and yet issues still persist that have not yet been solved. Prosthesis needs for children are particularly complex, due in part to their growth rates. Access to a device can have a significant impact on a child’s psychosocial development. Often, devices supporting both cosmetic form and user function are not accessible to children due to high costs, insurance policies, medical availability, and their perceived durability and complexity of control. These challenges have encouraged a grassroots effort globally to offer a viable solution for the millions of people living with limb difference around the world. The innovative application of 3D printing for customizable and user-specific hardware has led to open-source Do It Yourself “DIY” production of assistive devices, having an incredible impact globally for families with little recourse. This paper examines new research and development of prostheses by the maker community and nonprofit organizations, as well as a novel case study exploring the development of technology and the training methods available. These design efforts are discussed further in the context of the medical regulatory framework in the United States and highlight new associated clinical studies designed to measure the quality of life impact of such devices.
This is an official RESNA Position Paper on Clinical and Professional Practice. As such, it has been prepared in accordance with the specific guidelines and approval process defined by the RESNA Board of Directors for Position Papers. See http://www.resna.org/knowledge-center/position-papers-white-papers-and-provision-guides for a complete description of this procedure. Key aspects of this procedure include:
• Establishment of a Working Group of three or more experts to author the paper, using evidence from the published literature, documented best practices, and other input from experts in the field as the basis for the content.
• Circulation of the draft to RESNA members and others for a 30-day public comment period, and subsequent revisions.
• Review of the revised draft by the RESNA Board of Directors, and subsequent revisions.
• Final approval of the paper by the RESNA Board of Directors.
This paper is valid for five years from the final approval date. It may be revised over time to ensure that its information remains current.
Final approval date: November 2, 2017
This paper examines how products can be redesigned to allow flexibility for changes in a user’s condition to give them control and ownership over their care, while offering viable, cost-effective and sustainable healthcare solutions. By focusing on the case study of the Evolvable Walking Aid Kit, we aim to investigate to what extent a modular system which has been designed to incorporate principles of affordability, evolvability and emotional durability can benefit patients. The Evolvable Walking Aid is a modular kit which can be assembled to form a walking stick, crutches, a walking frame, and variations of these aids depending on the individual’s stage of their condition and fitting their anatomy. A co-design process was adopted across all stages of the project and two distinctive contexts, i.e. developing and developed regions of the world were targeted for design development. Through this case study, the rationale and potential for application of this concept to a broader context of inclusive design is suggested.
Background
The need for systematic methods for reviewing evidence is continuously increasing. Evidence mapping is one emerging method. There are no authoritative recommendations for what constitutes an evidence map or what methods should be used, and anecdotal evidence suggests heterogeneity in both. Our objectives are to identify published evidence maps and to compare and contrast the presented definitions of evidence mapping, the domains used to classify data in evidence maps, and the form the evidence map takes. Methods
We conducted a systematic review of publications that presented results with a process termed “evidence mapping” or included a figure called an “evidence map.” We identified publications from searches of ten databases through 8/21/2015, reference mining, and consulting topic experts. We abstracted the research question, the unit of analysis, the search methods and search period covered, and the country of origin. Data were narratively synthesized. ResultsThirty-nine publications met inclusion criteria. Published evidence maps varied in their definition and the form of the evidence map. Of the 31 definitions provided, 67 % described the purpose as identification of gaps and 58 % referenced a stakeholder engagement process or user-friendly product. All evidence maps explicitly used a systematic approach to evidence synthesis. Twenty-six publications referred to a figure or table explicitly called an “evidence map,” eight referred to an online database as the evidence map, and five stated they used a mapping methodology but did not present a visual depiction of the evidence. Conclusions
The principal conclusion of our evaluation of studies that call themselves “evidence maps” is that the implied definition of what constitutes an evidence map is a systematic search of a broad field to identify gaps in knowledge and/or future research needs that presents results in a user-friendly format, often a visual figure or graph, or a searchable database. Foundational work is needed to better standardize the methods and products of an evidence map so that researchers and policymakers will know what to expect of this new type of evidence review. Systematic review registrationAlthough an a priori protocol was developed, no registration was completed; this review did not fit the PROSPERO format.
Commercially available assistive devices (AD) may not always match individual needs of the patient. Sometimes substantial customizations or a new design is needed. New ideas, arising by involving the patient, could help many, but product development and marketing is hard.
We hypothesize that digital fabrication (DF), e.g. 3D printing, may be an opportunity to involve patients in the process of custom design and creation of personalized ADs. As DF is minimizing the requirement for manual activities, DF has the potential to enable people in creating ADs for personal use, despite physical limitations. However, co-design and the use of DF in AD provision is still in its infancy and scarcely reported in scientific literature.
We studied the literature, performed a mini survey and then conducted a case story of a person with severe upper extremity impairment who became a maker of her personal AD using 3D printing.
Implications of using DF as a key enabling technology empowering patients with physical limits to become active in personal AD provision are discussed.
We conclude that this topic merits a proper scientific investigation of systematically engaging patients as competent participants in development and realization of assistive devices and technologies.
Aim:
In Québec, Canada, the prevalence of children using powered mobility (PM) is not reflective of evidence supporting its use and for achieving developmental milestones. The aim of this study was to explore the perceptions of four key stakeholder groups in a metropolitan area regarding daily use, barriers, facilitators, and clinical practice associated with use of PM.
Methods:
Using convenience sampling, semi-structured qualitative interviews were conducted with children (n = 6), parents (n = 2), rehabilitation center occupational therapists (OTs; n = 4), and special needs school-based OTs (n = 6). Drawings were used as a supplemental data collection strategy with children. Interviews were audio recorded and transcribed verbatim to conduct thematic analysis.
Results:
Three overarching themes were identified: (1) "A sense of liberty, except…", highlighting environmental obstacles reducing social participation; (2) "A necessity, for better or for worse," covering benefits and drawbacks of PM; and (3) "First choice versus last resort," raising clinical differences related to provision, assessment, and training.
Conclusions:
Stakeholders' perceptions illustrated benefits of PM, yet use is contingent on the physical, institutional, and societal environments, leading stakeholders to feel both powerful and powerless as users, parents, or clinicians.
Aim
To explore the views and practices of paediatric occupational therapists and physical therapists in Canada and the USA regarding the implementation of power mobility for children with mobility limitations.
Method
This descriptive study utilized a web‐based survey that included questions pertaining to therapists’ decisions to trial and use power mobility, agreement or disagreement with statements developed from published practice considerations regarding power mobility, and the frequency of performing tasks related to power mobility prescription and training.
Results
Most respondents reported that child characteristics (e.g. cognition, safety awareness) were important factors in decision‐making about power mobility, whereas other child characteristics (e.g. communication abilities, age) were not as important. Family resources and home accessibility were also not considered important. The average age at which respondents considered power mobility for children was 2 years 3 months. The majority of respondents agreed with statements developed from published practice considerations and most frequently performed various power mobility tasks twice a year or less.
Interpretation
Although most respondents appeared to have positive views regarding power mobility, few appeared to actively perform power mobility tasks in their practice. Resources to support therapists in the early introduction of power mobility may be beneficial.
What this paper adds
• Occupational and physical therapists positively view early introduction of power mobility for children with mobility limitations.
• Few therapists actively provide early power mobility experiences.
• Power mobility training and monitoring power mobility devices are important therapist roles.
