I.Introduction
To keep pace with changes in disability policies, assistive devices for the handicapped have become an important means of ensuring the social participation of handicapped. As the disabled population increases and the disability category expands owing to acquired factors, the number of elderly people requiring assistive devices has increased suddenly in recent years, and the demand for assistive devices for the handicapped are increasing day by day as well[1]. Among the 79 items listed as assistive devices for the handicapped, electric wheelchairs and electric scooters are classified as electronic assistive devices. These items have been provided as insurance benefits since 2005. The government supports 90% of a device’s cost, meaning the lowest price among the base amount, the official price, and the actual purchase amount. When a device is purchased for a disabled person who has a rare incurable disease, 100% of the base amount is supported[2]. Electric wheelchairs and scooters are used by people who cannot walk, or whose arm movement is weakened or completely lost, or cannot operate a manual wheelchair[3]. Most electronic assistive device users are patients with a physical disability, brain lesion, heart failure, or respiratory failure. The use of electronic assistive devices is increasing owing to national support and, as a result, the rate of accidents involving electronic assistive devices is also increasing[4].
According to a press release, during the first half of 2015, the accident rate for users of electronic assistive devices increased, and institutional measures are urgently required to minimize this trend. Various safety-related studies concerning electronic assistive devices have been carried out to analyze the rate and causes of accidents; however, Korean studies have been conducted at a very limited level[5]. In principle, electric wheelchairs are not recognized as “cars” in the Road Traffic Act; therefore, by law, they should be operated on the sidewalk. However, many electric wheelchair users find it safer to drive on the road because of sidewalk obstacles such as curbs, uneven pavement, or billboards erected on the roadside[6]. In the event of a traffic accident caused by using such an unsafe road, however, no defensive measures can be taken. Given this situation of increased accident risk, it is necessary to establish a support system policy to compensate handicapped victims who are involved in road accidents. In reality, national support is difficult to obtain at the institutional level. Therefore, it is critical that guidelines be established for the prevention of accidents involving electronic assistive devices, as well as measures for dealing with traffic accidents involving electronic assistive devices[7]. Most new purchasers of electronic assistive devices do not receive proper safety education, and routine follow-up is lacking. Furthermore, there has been no research on accident prevention education for users of electronic assistive devices. Hence, in this study, accident cases involving electronic assistive devices were investigated to determine how accidents can be avoided, and to devise instructions for preventative measures for the handicapped of these devices.
II.Method
1.Subjects
In this study, 900 of the 31,848 handicapped registered in the National Health Insurance Service as users of an electronic assistive device were selected to complete a survey via mobile methods or mail under consent. The survey was based on the convenience sampling method, a nonprobability sampling method. The final 290 completed questionnaires were collected from July 10 to October 3, 2015.
2.Measurements
The questionnaire used in this study was constructed with reference to the studies of Lee[8] and Jung[9] and was developed through consultation with an assistive technology professor. The main content of this questionnaire consisted of general information, the status of electronic assistive device management, research on the status of accidents involving electronic assistive devices, and the status of prevention education for electronic assistive devices. During the development of the questionnaire, a preliminary test was carried out with 20 assistive technology experts, and questions not properly conveying the examiner’s intention, or questions that were difficult for examinees to understand, were modified.
3.Ethical Considerations
The data used in this study were collected from a structured self-reported questionnaire survey from July 20 to October 3, 2015. All details of this study’s procedures were submitted to the Science Research Council of Inje University. The IRB number is 2-1041024-AB-N-01-20150518-HR-245.
4.Analytical Methods
The research data collected were analyzed using SPSS ver. 19.0. Descriptive statistics were used to determine the general characteristics of the subjects, the status of accidents involving electronic assistive devices, and the status of prevention education, accident situations by the subjects.
III.Results
1.General Characteristics
More men(55.5%) participated in the survey than women, and the age ranges were on the order of 50s(27.6%), followed by 40s(25.2%), and then 60 or older(23.1%). The majority of subjects —179(61.7%)—were unemployed. The most common type of disability was physical disability(65.5%), followed by brain lesion disorder(32.7%). Disability ratings were on the order of 1st(50.3%), 2nd(22.8%), and 3rd(16.2%), while a slight majority of the subjects hand a disability for a 10~20 year period(51.7%), as listed in <Table 1>.
2.Status of Accidents Involving Electronic Assistive Devices
According to the results on the status of accidents involving electronic assistive devices, 171 users(58.9%) had experienced an accident. The types of accidents were collisions and falling down, and lower limbs(43.3%) were the most commonly damaged body parts. Treatment took two to four weeks(50.3%) in most cases. The causes of the accidents were careless product operation(42.7%), traffic accidents(34.5%), and mechanical defects(13.5%). Half of the safety accidents occurred on roads(50.3%), and at the time of the accident, users were either moving(56.7%) or transfer(24.0%). The most common length of use of an electronic assistive device at the time of an accident was less than two years(49.7%), while once or twice per year was the most common frequency of safety accidents, as shown in <Table 2>.
3.Status of Electronic Assistive Device Management and Prevention Education
The distribution of the type of electronic assistive device used was 57.5% for electric wheelchairs and 42.5% for electric scooters. The most common total length of time using the device was 1~3 years(53.5%). When subjects were asked about the regular management of their electronic assistive device after purchase, “I do not manage it” (69.0%) was the most common response, and the reasons for not managing it were “do not know how to”(51.5%), “hard to manage”(35.0%), and “burden of cost”(20.3%). With regard to the wearing of a safety belt, “hardly wear”(52.4%) was the highest response, while most subjects stated that they did not wear one because it was inconvenient. More than half of the subjects had received accident prevention education for their electronic assistive device(56.8%). Concerning the need for accident education, opinions were in the order of necessary(33.8%), very necessary(25.0%), and somewhat necessary (17.2%), with all opinions expressing some degree of necessity(76.5%) that accounted for a large majority. With regard to teaching methods for accident prevention, the most common opinion was that instructor-led hands-on training was the most appropriate method, and safety education should be carried out by the product supplier(39.6%)<Table 3>.
4.Accident Status According to General Characteristics
1)Areas of Injury According to General Characteristics
The damage rate to lower limbs was highest for subjects under 50~59 years of age, while the damage rate to upper limbs was highest for subjects under 40~49 years of age. For employed handicapped, mainly lower limbs were damaged in accidents. Likewise, handicapped with a 1st rating mainly suffered from damage to lower limbs. See <table 4>.
2)Difference in Causes of Accidents According to General Characteristics
Traffic accidents were the most common cause of accidents among handicapped aged 40 or older, while careless product operation was the most common cause of accidents among handicapped who were 30~39 years of age. For those who were employed, accidents caused by careless product operation were the most common, and this accident rate increased among users with a shorter disability period. See <Table 5>.
IV.Discussion
Among OECD countries, Korea is recognized as a country with a high accident rate for handicapped who use electronic assistive devices[5]. Although the accident rate of electronic assistive device users is increasing, there are no current institutional measures in place to resolve this issue. Hence, the reduction of the accident rate and measures to prevent accidents were evaluated in this study, which investigated whether electronic assistive devices were being used safely and reviewed the accident characteristics of users.
The number of people using electronic assistive devices is continuously increasing. Likewise, the number of electronic-assistivedevice- related accidents is increasing steadily. Consumer complaint consultations deal mainly with quality and follow-up management. Complaints about quality include the automatic discharge of batteries or defective charging, wheels falling off, or uneven wear. Sudden stops during operation and malfunctions also account for a considerable number of complaints[10]. In the United States, many accidents have resulted owing to an increase in the operating speeds of electronic assistive devices. If a road is suddenly closed while a person is driving at high speed, or an impassable sidewalk is encountered, the risk of an accident increases. This speed control problem may cause injuries to pedestrians as well as to the electric wheelchair operator[11]. In Japan, electric wheelchair use by the elderly and handicapped has rapidly spread owing to ease of operation, but according to statistics, between 2008 and 2012 more than 200 traffic accidents happened each year. This indicates that more attention to user safety is required[6].
As shown in this study’s results, the common accident types include collisions, falling, falling down, and damage to lower limbs. Damage to the lower limbs was found to be severe in most cases when such accidents occur. In an inquiry conducted by the Korea Consumer Agency in 2011[12], lower limbs accounted for the highest proportion of damaged body parts owing to accidents involving electronic assistive devices. It is believed that the higher risk of damage to lower limbs is a result of the reduced controllability of pelvic limbs by paralysis. Looking at accident cases, most accidents are caused by falling and falling down in homes or on roads, and it takes more than one month of treatment to recuperate in most cases. In order to reduce this risk, it is necessary to educate users on subjects such as product operation, precautions when driving outside, and defective equipment checks, because most handicapped and elderly people recover slowly from fractures and enter[3]. In this study, the most frequent cause of accidents was careless operation, which means that follow-up management, such as consulting and education, is not being properly done. Hence, regular and mandatory inspections and follow-up management, such as an aptitude test for driving licenses and periodic device inspection, should be immediately introduced to handicapped who use electronic assistive device[13]. Most users were found to use electronic assistive devices every day, but rarely wore a safety belt owing to discomfort. Lack of safety equipment and user carelessness may lead to a serious accident. Therefore, it is necessary to prepare for this and improve users’ safety awareness[14].
Looking at the status of accident prevention education for electronic assistive devices, most users did not receive any education, indicating that prevention education is not conducted well. However, the majority of handicapped thought that accident prevention education was needed, and most disabled people wanted to learn about situations in which they should be careful through guided hands-on training. Thus, it is necessary to conduct hands-on traffic safety training regularly for seniors’ groups and disability organizations[15][16].
Looking at the general characteristics of accidents, there were more collisions and falls at older ages, and the injury rate to the lower limbs was higher among handicapped aged 50 or older. The most common causes of accidents for disabled people aged 40 or older were traffic accidents, while accidents resulting from careless product operation were most common among handicapped in their 30s. The highest accident rate was found among men in their fifties[17]. Moreover, in the United States 2000 Census, the highest accident rate of 17.7% was observed in the over-65 age group[18]. Taking safety precautions is especially important because of the potential for lower-limb damage to elderly people with handicapped[19]. Furthermore, many accidents are caused by careless operation among users with shorter disability periods, and therefore continuous education for the safe use of electronic assistive devices should be conducted.
Reflecting on these results, the following matters should be addressed at the policy level to prevent accidents involving electronic assistive devices in the future. First, it is necessary to place a warning(safety marker) on electronic assistive devices in order to prevent accidents such as falling or falling down. Program development and safety education for the proper use of electronic assistive devices should be regularly carried out by related agencies or local governments. This education should cover such topics as device structure and precautions when moving, and should target electronic assistive device users and caregivers.
Second, the majority of users are unaware of the appropriate responses because there is no specific training provided in Korea for the safe operation of electronic assistive devices. Moreover, there is a higher risk of accidents in Korea owing to the poor pedestrian environment. Although education on theory and the distribution of booklets would be good measures to educate users on accident prevention and enhance operational experience, the most effective measure would be education through practical exercises. Regular practical traffic safety education is necessary for the elderly and disabled. Moreover, by providing systematic safety instructions about the use of electronic assistive devices, users will have to be certified before and after use of electric assistive devices. Safety guidelines should include clear and organized content on all processes from device repair requests to the completion of repair and follow-up management[3]. In addition, prediction standards for unexpected situations and usage patterns associated with safety, such as safety belts, must be learned.
Third, since many accidents occur on bumpy surfaces or uneven slopes, it is necessary to create an environment that electronic assistive devices can safely traverse. The recent barrier-free movement in Korea provides comfortable and safe living facilities for seniors and physically challenged people; the architectural design of these accommodations and the surrounding environment make mobility easier and safer. When this type of environmental consideration becomes widespread, the independence and quality of life for handicapped will be enhanced[20].
Finally, in order to prevent accidents involving electronic assistive devices, it is necessary to establish standards for strengthening the quality of these devices. In 2013, the Korea Consumer Agency announced that a considerable number of electric wheelchairs had safety issues and did not meet quality standards. Even if users have received training on the safe operation of their devices, it is difficult to avoid accidents if the device is defective. Hence, the Ministry of Food and Drug Safety should establish standards of quality for the manufacture of electronic assistive devices, including criteria for quality measurement and enhanced permissions management.
V.Conclusion
The findings have important implications that accident cases involving electronic assistive devices were investigated to determine how accidents can be avoided, and to devise instructions for preventative measures for the handicapped of these devices. The results of this study are limited in that they cannot represent all circumstances of handicapped who use electronic assistive devices. Furthermore, since the target areas of the survey were mainly confined to urban areas, the results do not represent the experiences of handicapped in rural areas. In future research, expanding the geographical area of the survey subjects will deliver more thorough results. Moreover, additional research is required to develop and verify the effectiveness of an accident prevention manual for people who use electronic assistive devices.