Participants were recruited from an amputee support group affiliated with an academic medical center in a large metropolitan area. Eight members of the amputee support group, ranging in age from 29 to 65 years old, were selected to participate in the one-day event. Upon arrival at the short track speedway, five male and three female participants provided surveys with basic demographic information including driving history and challenges associated with daily living. Then they signed informed consent documentation and were oriented to two adapted vehicles that were used for the one day event.
Figure 1: Participant has entered the seat base and used the rotator unit on his right leg prosthesis to create space to swivel into the car
The first vehicle was a standard 4-door sedan with hand control modifications to be used during training sessions on the street course. The second vehicle was a stock race car with modifications to allow persons with disabilities to safely enter/exit and control the car. These modifications include: a removable outer body panel exposing a door opening in the frame, and a custom designed seat base that moves fore and aft and swivels out into the door opening for transfer into the car. Due to the variety of special needs to drive for individuals with disability there are multiple options for control including: conventional steering wheel and a left foot gas pedal; manual hand controls (a fold up pedal blocker plate is used with manual hand controls to prevent inadvertent leg interference with the pedals); and electric gas and brake controller. All drivers electrically operate the automatic transmission.
The steering column is easily modified to adjust for driver’s needs. The steering gear box is modified for easier steering and there is a tandem vacuum booster master cylinder to make it easier to stop the car. Both the steering and the brake systems have automatically activating back up systems in case of OEM failures such as fluid loss, vacuum loss or electrical issues. Lastly, on the passenger side of the vehicle there is dual steering, brake and gas with switch controls for turning off the engine and activating the back up systems.
The one day event consisted of training, simulation and racing components:
Training:
- Led by driver training specialists, participants were instructed in anti-lock braking systems and introduced to the training vehicle.
- On the street course, each driver demonstrated competency in high speed braking using hand controls and performed handling and maneuvering drills using an adapted steering wheel.
Simulation:
- Each participant trained using the VXP driving simulator equipped with a MOMO Force Feedback Racing wheel and iRacing hand controls and software. The iRacing software offers a wide variety of scenarios preparing the driver both mentally and physically by teaching and testing reaction time, accident avoidance, hand eye coordination and many other necessary driving skills.
Racing:
- Finally, each driver participated in adapted stock car racing around a short track with hand controls, an adapted steering wheel and accompanied by a professional race car driver in the passenger seat with a steering wheel and acceleration and deceleration control.
Following the event, participants were given the Psychological Impact of Assistive Devices Scale (PIADS) to assess the effects of the adaptive motor sports program on functional independence, well being, and quality of life. PIADS is a 26-question survey designed to examine the psychosocial impact of different assistive technologies. Each question is a word or phrase used to describe the affect of the assistive technology on the participant’s personal traits and emotions. Participants ranked each question on a scale of -3 to 3. A negative score indicates a decrease in the particular trait or emotion while a positive score denotes an increase in the trait or emotion. Each survey was then scored using the PIADS scoring sheet. Finally, the individual scores were averaged for each of the three categories.
RESULTS
Figure 3: Average PIADS results for all participants by category
All participants were able to complete all components of the event. Each person was able to successfully learn how to use the adaptive technology on the simulator and effectively apply that to the actual short track experience. Additionally, all participants reported enjoying the experience and described feelings of exhilaration, accomplishment and teamwork based on the event. The PIADS showed highly positive results in participants’ competence, adaptability and self esteem. As table 1 illustrates, the event had a positive impact on individuals at each level of amputation along all metrics evaluated using PIADS with the upper extremity level showing the highest scores in all three categories.
Table 1: PIADS results by level of amputation
| Amputation Level |
Competence
|
Adaptability
|
Self-Esteem
|
Transradial
|
2.50
|
3.00
|
2.88
|
Hip disarticulation
|
1.42
|
2.33
|
1.25
|
Transfemoral
|
2.20
|
2.61
|
1.84
|
Transtibial
|
1.69
|
2.20
|
1.81
|
Figure 3 reveals a strongly positive response from the event in all three categories of the PIADS indicating all participants experienced an increased level of that trait or emotion.
DISCUSSION
This event utilized rehabilitation engineering and assistive technology to allow persons with disabilities the opportunity to overcome obstacles and push the limits of their potential. Our experience demonstrates a safe and effective method of rehabilitation for amputees that can improve their competence, adaptability and self esteem. Furthermore, the design of this event using a training program, a driving simulator, and a racetrack experience, is one that can be duplicated and improved upon.
This experience provides a unique perspective to addressing psychological issues using rehabilitation engineering and assistive technology for adaptive sports. It allows the participants to try something new, fun and challenging while in a safe environment. Our goal is to introduce our amputee patients to programs that allow them to overcome barriers and return their locus of control. Further development of adaptive sports is needed to address the goals of our diverse amputee patient population.
SUMMARY OF TECHNICAL CONCEPT
One of the many challenges facing a warfighter with serious spinal or leg injury wounds is to regain their mobility and independence in today’s society. Both the Department of Defense (DoD) and the Department of Veterans Administration (DVA) continue to seek patient-focused rehabilitation and education technologies to assist these warriors in achieving this independence. The ability of a wounded warfighter to re-acquire a driver’s license is a key DoD and DVA goal. Patients must relearn to drive within their new physical limitations. A variety of devices are available for adapting vehicles to needs of the disabled, especially hand controls for those who have limited or no use of their legs; however, there is a lack of simulation for these devices, requiring patients to learn the new controls in-car. Limited familiarization opportunity leads to a longer training period at increased cost and increased risk on the road. Simulation training increases familiarization in a risk-free environment, while adding another productive therapeutic exercise to the patient’s rehabilitation program. The Military Advanced Training Center at Walter Reed Memorial Hospital is employing a conventional driving “simulator” to rehabilitate warfighters with disabilities by teaching them how to drive. This system is composed of a donated pickup truck cab and body from General Motors, scenario software from America’s Army, and a variety of projectors and screens. Unfortunately, this system is large, ‘ad hoc,’ has little performance measurement, and is not mobile or easily replicated for other sites. Adaptive Motorsports & Wellness proposes the development of a stand-alone, immersive and adaptive PC-based “Driver Rehabilitation Training System (DRTS).” This innovative approach consists of fusing a Commercial-Off-the-Shelf (COTS) gaming architecture with a low-cost hardware simulation of a hand-controlled acceleration and braking system and advanced training technology. Our approach addresses the military’s driving rehabilitation challenge with mobility, portability, enhanced training effectiveness, and reproducibility. Sonalysts has extensive background in military training, as well as computer-based military simulation and commercial gaming. We will leverage this expertise to develop a comprehensive suite of software driver training scenarios focused on preparing disabled warfighters to successfully pass all driver’s license certification requirements. Scenarios would place the patient in first-person, real-time control of a simulated passenger vehicle, in realistic traffic situations in an urban environment. Appropriate measures will be developed to assess the patient’s performance and provide coaching during the scenario, and summary remediation at the end of each scenario. As the baseline environment for the training scenarios, We envision creating an automated city with a variable volume of traffic, functioning traffic signals, and built in monitoring of adherence to traffic laws.
TECHNICAL RATIONALE AND APPROACH
Rationale. Driving a car is an essential capability to ensure mobility and independence in today’s society. It is also a barrier to full opportunity for wheelchair-bound and other disabled military warfighters unable to drive. Rehabilitation of military patients with neurological and physical disorders, though, poses a significant challenge to the medical community. Current methodologies are reclusive in nature and require a significant time commitment for effective neuro-rehabilitation to occur. These treatment modalities are repetitious and tedious, making it difficult for the patient to sustain interest over long periods of time. This frequently leads to decreased motivation and participation with therapeutic treatments and limited compliance with home therapy regimens, which may adversely affect the potential functional outcome and level of functional independence that can be achieved.
VXP "The Next Generation" driving simulator is a stand-alone immersive, interactive, adaptive, and augmented reality training technology. It is an innovative approach combining a COTS gaming framework with the low-cost VXP TM hardware controller (full-sized mechanical steering wheel with a hand controlled brake and accelerator which interfaces with the software component to control the simulated vehicle), with advanced training technology to produce a simulation of a hand controlled acceleration and braking system for disabled warfighters. As such, it also addresses the military’s driving rehabilitation challenge with mobility, portability, and reproducibility.
XXXXX innovative technical approach of combining this gaming framework with a hardware controller will produce a realistic, engaging, and fun DRTS system; and with the addition of advanced training technology component, DRTS will be a system that quantifiably improves and/or maximizes training effectiveness through coaching and performance measurement. XXXXXXXX
This proposal directly supports the goals of the Defense Medical Research and Development Program (DMRDP) to discover and explore innovative approaches to protect, support, and advance the health and welfare of military personnel; and to accelerate the translation of technical advances into the treatment of casualties, as well as warfighter rehabilitation and education that can be applied in theater or in the clinical facilities of the Military Health System (MHS).
Approach. Our overall approach will be to follow a standard “waterfall” development life cycle which includes requirements determination, design, implementation, and testing phases.
The process also includes a structured and controlled management process throughout the lifecycle of the project. This includes a detailed work breakdown structure, schedule, and cost constraints. XXXXXX envisioned technical approach for the Adaptive Motorsports & Wellness system includes:
1. Subject Matter Expertise (SME) . XXXXXX, and the production of driving aids for the disabled. We are uniquely qualified to produce DRTS.
2. A Hardware Controller . We plan on leveraging the VXP TM hardware controller developed by consultant, Adaptive Motorsports & Wellness, to mitigate risk. A prototype version of the controller has already been built. VXP features a custom push-pull accelerator/brake control integrated with an off-the-shelf Logitech Force Feedback Racing Wheel. VXP maintains the COTS device’s plug-and-play capability; and is compatible with a wide variety of driving games and simulations.XXXXXXX software Provides an innovative and proven driver’s training tool that addresses the major cause of vehicle incidents—poor decision making.
3. A Simulation Component . Sonalysts will conduct a “build or buy” analysis of currently available COTS driving simulations and game engines to assess their suitability for modification to meet the training requirements of a driver rehabilitation program. The software component will provide the “virtual reality” scenario simulation of the vehicle, with embedded performance measurement. XXXXXX training in simulators is much more efficient and effective compared to traditional in-car training. There are a number of reasons for that:
- Driving simulators focused on developing in a way that effectively teaches the required behaviors and provides an innovative and proven driver’s training tool that addresses the major cause of vehicle incidents—poor decision making.
- Allows practice of critical decision-making skills in a risk-free environment.
- During the lessons, the simple traffic situations are taught first, but as the lessons progress traffic situations become more complex. This results in faster recognition of situations and hazards and a faster correct response to these.
- Traditional on the road training typically overload a beginner student with a multitude of different things require attention. They have to attend to, and do, a number of things simultaneously which they may not have the skills for yet.
- During a typical on-road lesson, teachable moments occur more or less randomly, XXXXX lets you customize your own scenarios to replicate collisions that occurred in your agency
4. Advanced Training Technology and Performance Measurement . XXXXX has extensive past performance building advanced training technologies and clearly understands that without appropriate assessment and coaching, simulations can allow students to practice bad habits as well as good. Our entering goal for the DRTS system is to produce a system that can observe the state of the world, form expectations about what a given student should do when presented with that situation, compare the student’s actual performance to those expectations, and then provide coaching that is tailored to both the student and the performance context. For this purpose, we intend to leverage XXXX. Teenage drivers share common learning challenges with physically challenged drivers:
- XXXXXX driver training Improve your teen’s odds with Driver Training.
- State-of-the-art technology in these machines helps ensure that you receive realistic and useful hands on training. “The risks are simulated, the benefits are real!”
- Simulator sessions have a playback option. Our instructor can playback a scenario and use it to “teach” a correct response to a situation. It is immediate feedback to a student and helps them develop critical decision making and judgement skills.
- Instructors can coach the student how to better handle the situation and do the exercise again. This fast and systematic feedback increases the speed at which the student develops the necessary skills.
- In a simulator the student trains in a safe environment with no stress. There can be significant consequences when making a mistake in a vehicle. In a simulator you learn from your mistakes
Rough Outline of Film Script:
VISION: share images of 9-11-01 we where at New Hampshire Motor Speedway doing a fund raiser for US Army Recruiter Wives Association of Family Readiness Division when planes hit the towers.
LETS ROLL!
Filming
1) Maybe we could open with Adaptive Motorsports & Wellness (at that time Hanaford Associates) doing a ride & drive fund raiser at the Speedway, morning of 9-11-01...
2) Maybe include tiny kids in a class room (including one in a wheelchair or prosthetic leg) morning 9-11-01
3) EXPLOSION of 9-11 images of planes hitting the tower, people running madly down the street - fire Fighters and civilians ...
4) President Bush declaring War...world change from this day forward
5) Vets coming home to Walter Reed, Bethesda or another HUGE service provider the twin towers under attack...
6) President Obama saying war is over,
7) Marathon Bombing
**8) then fade in and fade out to hospital and VXP driving simulator-then to Dana Bowman dropping out of the sky with 7800 sq ft American flag -then into hospital images-then to gaming-then to racecar with a message "this is where the American flag with Dana, drops and the reality starts with VXP (XXX branded VXP and racecar....but rehabilitation never ends...the world is forever changing etc)
**9) maybe one of those kids in a class room (#2 above) returning home saying something like this is where i was and this is where i am today....showing VXP powered by XXXXXX....changing the face of drivers education for ambulatory and those who are afflicted by physical challenges through no fault of their own (like 9-11-01, military, or fire fighter/cop)
