Wheelchairs: from engineering to inclusive design Lucy A Zimmermann InnovationRCA, Royal College of Art, UK
[email protected] Michael R Hillman Bath Institute of Medical Engineering, UK
[email protected] P John Clarkson Engineering Design Centre, University of Cambridge, UK
[email protected]
Keywords inclusive design, wheelchair, assistive technology, styling
Abstract This paper describes a study to investigate ways to improve the design of assistive technology with a particular focus on wheelchairs. Assistive technology by its very nature is designed to be functional for a user group that includes disabled and older people. Hence the study looked to the emerging field of inclusive design to inform the emotional and aspirational aspects of human-technology interaction. It is proposed that people who design assistive technology, or who make the design decisions, may consider the concept of “people having emotional and aspirational needs in relation to products” to be rather abstract and perhaps not relevant. To counter this view, the study researched and developed reasons why emotional and aspirational aspects of design are relevant to wheelchair development. It is proposed that such rationale could form the basis of a design tool, illustrating the relevance of emotional and aspirational design, to be applied to assistive technology in general. The study also indicates how inclusive design, within the field of assistive technology, might be encouraged through events in society. Analysis of the development of NHS
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(National Health Service) spectacles provides suggestions as to possible future directions for wheelchair design.
Introduction The UK government describes inclusive design as “a process whereby designers ensure that their products and services address the needs of the widest possible audience” (DTI, 2001). In assistive technology the needs of the “widest possible audience” are certainly addressed. However, although the basic functional needs of disabled and older people are considered, the wider emotional and aspirational requirements are often ignored. Whereas marketing techniques have encouraged the design of consumer products that are desirable to ensure sales (Hofvenschiold et al., 2003), assistive technology products are often unattractive (Allen, 2002). This limits the market and often stigmatises those who need to use such products for functional reasons or due to lack of choice.
Research methodology The study began by confirming that the role of styling in wheelchair design is in general not considered to be important. This was achieved through observation of wheelchairs used and available to the public at two disability product trade shows and through informal interviews with four wheelchair users. In addition, the media representation of wheelchair users and wheelchairs was analysed through three methods. Media reports describing two similar products (one disability product and one non-disability product) were compared. Marketing material from nineteen wheelchair companies was analysed using a structured method based on that used by Thomas (2001) in her semiotic analysis of advertisements for rehabilitation products. Finally, the representation of disability products in design literature from the last 20 years was also studied. The reasons for this lack of styling were then investigated through further literature (mainstream, design and disability) analysis, interviews and a visit to the Imperial Science Museum Reserve. In order to limit the number of interviews, interviewees were chosen who were particularly well-informed and had a special interest in this field, and when necessary further literature research on subjects raised during the interviews was undertaken. Thus semi-structured interviews were conducted with two occupational therapists, three medical engineers, two people working in the design field and seven wheelchair manufacturers. The interviews with the manufacturers were usually kept brief in order that the manufacturers’ “gut reactions” to questions were obtained, rather than the answers that the interviewees on reflection thought should be given. The interviews with the engineers and those working in the design and medical fields were longer. Although a short list of questions was prepared before the interviews, the structure was allowed to be flexible to enable additional topics to be covered.
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In order to look to the future and to investigate means of encouraging more inclusive design, literature was analysed both for examples of patterns of design development and for evidence that points to future possible developments. A key part of this research was the analysis of the historical development of spectacles and the identification of the events that were significant drivers towards inclusive design. The historical development of wheelchairs to date was then analysed against these events.
Wheelchair aesthetics The study found that wheelchairs and assistive technology usually lack styling and consideration of the lifestyle and aspirations of the user.
Negative influences Use of 1930’s style today Wheelchairs today are heavily influenced by 1930’s design. Many models closely resemble the Everest & Jennings design from 1932 (Figure 1). Although this wheelchair was a significant development in 1932, providing increased freedom through its portability and light-weight, is this design still appropriate today? Fashions change and a product that does not develop, however good the initial design, will look dated.
Figure 1: a) Everest & Jennings wheelchair developed in 1932 b) typical wheelchair in 2003
Lack of consumer power One cause for the lack of development is the absence of consumer power that the purchasing system, at least in the UK, has created (Bennington et al., 2003). Poor designs were not rejected and many assistive technologies have been designed to the medical model of disability (Newell, 2003). Until 1996, NHS wheelchairs were chosen by healthcare professionals, mainly occupational therapists, who were trained to prescribe wheelchairs on the basis of function only (Pockney, 2003). The consumer and the normal user-driven market conditions were thus absent.
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In 1996 the NHS voucher scheme was introduced. This enabled the user to purchase their chosen wheelchair from an approved supplier. “Patients” thus became “consumers”, a change evidenced by the behavioural change of wheelchair users themselves (many were no longer simply grateful to accept a free product, but instead expected goods of a certain quality) and by wheelchair companies who now identify disabled people as potential consumers (Bushnell, 2003).
Designers are often not consumers Despite the lack of market conditions, the question remains why wheelchairs were so designed in the first place. Designers are often criticised for designing for themselves to their tastes without consideration of other users (Keates and Clarkson, 2002). Whereas for designers who develop wheelchairs this is less likely to be the case and they will be aware that they are designing for someone else (designers often do not use wheelchairs themselves). However, the designers may still not be fully aware of all the needs including the emotional and aspirational needs of the end users. In contrast significant advances are often made when wheelchair users develop new designs, e.g. Herbert Everest of Everest & Jennings.
Image of a wheelchair user The image of a wheelchair user is heavily influenced by the perception that the majority of users are senior ladies who are sometimes thought of as colourless, characterless and uninteresting in terms of design (Gheerawo and Cassim, 2003).
Company policy Designers do not usually work in isolation, but within a company, where company policies play a role. Although wheelchair companies have good intentions, anxiety of not wanting to patronise or make fun of disability issues often results in extreme cautiousness that stifles innovation in styling (Pockney, 2003).
Media image The media often implies that styling of disability products is irrelevant. Consider, for example, the comparison of BBC reports about two very similar products, both invented by Dean Kamen and one having inspired the other: the iBOT (a powered wheelchair that climbs stairs and raises the user up to a standard eye level) and Segway (a twowheeled, powered scooter for the mainstream market). Whereas the Segway was reported to resemble “an old-fashioned lawn mower” (BBC, 2001), no criticism (good or bad) was made of the appearance of the iBOT (BBC, 2000). Manufacturer comments within the reports also had different focuses – the iBOT manufacturer comment concerned only technical details (BBC, 2000), whereas the manufacturer of the Segway talked about feelings and emotions – the Segway was said to “function … like a dance partner able to anticipate your every move,” and it was stated that “it doesn’t feel like technology at all, … it just feels right” (BBC, 2002).
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Positive influences People with disabilities as designers During the last 40 years positive influences on wheelchair design have also emerged. The results can be seen in the designs of leading wheelchair companies, such as the stylish and desirable RGK wheelchairs. Significantly, RGK also employs disabled designers and engineers.
Figure 2: RGK "Interceptor" basketball chair
War War has always led to technological developments, such as the microwave oven, which in peacetime can then be used by and aid the civilian population. A notable influence within the field of assistive technology was the Vietnam War which created a community of disabled young men who were unwilling to lose independence due to disability (Coleman et al., 2003). These men were previously active in society and demanded that the incompatible environment be adapted. Although the emphasis was on functional developments of wheelchairs and prosthetics to enable the employment of the user (Cassim, 2003a), this demanding for the recognition of the same rights as others was an early step towards recognition as consumers.
Sport Particularly since the 1980’s sport has had a significant influence on wheelchair styling. Although the development of sport wheelchairs was functional, it changed the public perception of wheelchair users. Wheelchair users were no longer viewed as weak and passive, but as fit, active and independent individuals (Porter, 2003).
Engineering advances The original Everest & Jennings wheelchair was designed using materials appropriate at that time, namely mild steel tubing. However in the majority of cases, this approach has not moved forward. Engineering advances and the development of new materials should give new freedoms in design enabling better performance and a more modern look. As is shown by bicycle development, use of aluminium and other lightweight materials can allow the use of fewer oversize tubes rather than the braced framework of traditional
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steel tubing. More radically the ability of carbon fibre to be moulded allows the tubular approach to structural design to be replaced by a more three dimensional or monocoque approach. Wheels are visually one of the most prominent aspects of a wheelchair, so replacing a traditional spoked design with a moulded plastic or carbon fibre wheel makes a significant difference. Advances in the biomechanical analysis of wheelchair propulsion have led to new understandings of the seated position and stability issues of wheelchairs, impacting on the overall appearance of the chair.
Is inclusive design of wheelchairs necessary? To create motivation for change, arguments that emphasise why such change is necessary are given.
Reason 1: Reduction of stigma Wheelchair users still contend with the stigma that can be associated with being disabled. Research has shown that poorly-designed wheelchairs can increase stigma and suggest illness and weakness (Browning et al., 1996), whereas well-designed wheelchairs can reduce stigma and increase social acceptability (Close, 2001).
Reason 2: Perception of wheelchair user Products that we associate ourselves with (e.g. through use, ownership or wear) affect how the identity and lifestyle of the user are perceived (Cassim, 2003b). For products that provide mobility such as cars (or wheelchairs), it can be said that they become an extension of the body (Allen, 2004). This thinking is supported by the reaction of the public to wheelchair users – not the person, but the combination of person and wheelchair, is normally perceived (Fields, 2003). The wheelchair styling thus communicates a suggestion of personality, age, gender, income and occupation (Pockney, 1999) and influences others’ reactions to the user. Designers should thus recognise their influence upon the perceived identity of a wheelchair user and realise the importance of styling.
Reason 3: User choice and individuality The wheelchair community is a diverse group of individuals. However, the present relative homogeneity of the appearance of different wheelchairs can hide the individuality of the users (Barber, 1996). Warwick and Cavallaro (Kennington, 1998) suggest that the physical and mental fit of clothes may be wrong. As both clothes and wheelchairs affect the perceived character of the wearer or user, it is therefore argued that this also applies to wheelchairs and hence that the mental fit (through styling) and the physical (functional) fit of a wheelchair can also be wrong. Some users for example wish for their wheelchairs to dissolve into the background, whereas others prefer to have an eye-catching design (Fright, 2003). Hence a broad range of wheelchairs is required.
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Reason 4: Encouragement of wheelchair acceptance Some new wheelchair users are reluctant to accept that they need a wheelchair, as it emphasises their deterioration of physical health and loss of mobility (Evans, 2003). The appearance of a wheelchair is also a dissuading factor (Ballinger et al., 1995), as is its public image. An example is provided by Mr Johannes Breuer who can only walk 100 metres. He refuses to use a wheelchair and instead purchased a Segway, despite the considerable extra trouble involved (Chors, 2003).
Wheelchair design in the future The study questioned how the more inclusive design of wheelchairs could be encouraged. A significant part of this research involved the analysis of UK spectacle design since the 1930’s. Spectacles, like wheelchairs, used to be “medical products” prescribed to patients by the NHS and their styling was considered unnecessary. Spectacle design is today inclusive with both style and function being important.
The inclusive design of spectacles On analysis of the recent development history of spectacle provision by the NHS, the following events were identified as significant drivers towards inclusive design. Events 1 to 5 are largely based on analysis of Lewis’ NHS spectacles history (Lewis, 2001).
Event 1: “Medical products should not be styled” – users are patients NHS spectacles were in the 1930’s labelled as medical appliances. This dictated that styling considerations were not valid – spectacle wearers were patients without consumer rights.
Event 2: Psychological need for styling identified In 1937 the psychological factors associated with spectacles were recognised within the optical trade. Glasses were considered to cause social humiliation and to mark a defect. However, the authorities considered stylish glasses to be inappropriate for the health service, and only “adequate” spectacles were provided.
Event 3: Users start to be recognised as consumers and demand stylish products The Consumer Association complained in 1969 about outdated spectacles and a lack of choice.
Event 4: Government recognition of importance of styling In 1976 the government acknowledged the importance of styling for glasses. However, the lack of styling was maintained as a deliberate political tactic to limit the demand for NHS spectacles.
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Event 5: Specialist designers develop stylish products Spectacle wearers desired choice and styling. A few designers developed stylish products.
Event 6: Limited availability of stylish products Styled glasses became available to those with the finances and contacts.
Event 7: Media recognition and effect on public opinion In 1991 the design press recognised the aesthetic value of glasses. It was declared that “Eyeglasses have become stylish” (Busch, 1991).
Event 8: Wider availability of styled products Stylish glasses became more widely available via the NHS and through high street outlets.
Event 9: Blurring of reason for use: fashion or function? During the 1990’s glasses started to be seen as products with an aesthetic value similar to that of jewellery. Spectacles became fashion accessories, with up to 20 % of some brands of designer glasses having clear non-prescriptive lenses (Busch, 1991).
Event 10: Inclusive design becomes the norm Today with glasses, and especially sunglasses, it is no longer clear if the buying decision is functional or purely aesthetic. Glasses were even adopted by pop star Anastacia as her trademark. Spectacle design today addresses both function and form, i.e. inclusive design within this field is now normal.
The inclusive design of wheelchairs? Having identified this chain of events that led to the inclusive design of an assistive technology, it was asked if wheelchairs might also develop in this direction. The first six events have already taken place in wheelchair design (evidenced in this text). Speculation as to whether events 7 through 10 might happen raised event 7 as the main hurdle, as media and public recognition of wheelchairs as desirable seems at first unlikely. However this would simply require history to repeat itself. In the eighteenth century French Court wheelchairs or “roulettes” were sufficiently stylish and desirable to be used by the disabled and non-disabled (Bartolucci, 1992). Similarly, Woods and Watson (2004) discuss how the Bath Chair came into fashion during Victorian times for use by wealthy ladies at the seaside. Literature also provides further support – other researchers have through different reasoning concluded that wheelchairs will become stylish items of convenience. For example, Underhill (2000) believes that the aging of the baby boom generation and the resultant increase in wheelchair users (especially those who view themselves as consumers) will have this effect and that exclusive brand designs of wheelchairs will become available.
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Figure 3: King Phillip of Spain owned an elaborate upholstered wheelchair
Inclusive design for other assistive devices? Having identified a chain of key historical events for spectacle design and proposed that it could apply to wheelchair design, the study ended by questioning if this process could be applied to other types of assistive technology and if it could be a useful research tool. Have other assistive technologies already followed this route to inclusive design? Might other assistive technologies achieve inclusive design through this route? Can knowledge of this chain of events be actively used as another means of encouraging and inspiring inclusive design?
Conclusions The study presented in this paper identified four key reasons why the styling of wheelchairs is important and presented these reasons such that they may be used as a designtool to illustrate the relevance of emotional and aspirational design to assistive technology. The study also identified an important series of events that took place in society during the development of spectacles from unstyled medical products to inclusively designed fashion accessories. It was proposed that wheelchair design could also develop to become inclusive via this route. The study concluded by questioning whether this series of events within society could be applied to other assistive technologies as another means of actively encouraging and inspiring inclusive design.
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Acknowledgements Figure 1 Everest and Jennings ®, courtesy of Graham-Field Health Products and University of Pittsburgh, Rehabilitation Engineering Research Centre (RERC), wheelchairnet.org Figure 1 b courtesy Medisave http://www.medisave.co.uk/acatalog/medisave_ecatalogue_Mobility_aids_3.html Figure 2 courtesy RGK wheelchairs Figure 3 courtesy University of Pittsburgh, Rehabilitation Engineering Research Centre (RERC), wheelchairnet.org
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