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MD Step-climbing wheelchair
clears panel
from the Atlanta Journal-Constitution,
November 22, 2002
For more articles visit
www.bridges4kids.org.
Stairs soon may no longer be insurmountable obstacles for some
of the nation's 2 million wheelchair users.
The first wheelchair that can climb stairs -- plus shift into
four-wheel drive to scoot up a
grassy hill and even elevate its occupant for
eye-level conversation -- took a major step toward the
market Wednesday, as advisers to the
Food and Drug Administration unanimously recommended it
be allowed to sell.
But the panel backed a few limitations on the Independence
iBOT 3000 Mobility System -- which uses sensors and gyroscopes
to balance on two wheels and
navigate stairs -- including that it be sold only with a
doctor's prescription and that users undergo strict training
to ensure they can drive it safely.
The FDA isn't bound by its advisers' recommendations, but
usually follows them -- and it
granted the iBOT a special fast-track review reserved for
important new technology, meaning a decision could come
in a few months.
How does it climb? Most wheelchairs have two big back wheels
and two smaller front wheels. The
iBOT has four wheels the same size that rotate
up and over one another to go up and down steps.
Well-known inventor Dean Kamen created the iBOT, and he says
wheelchair users tell him another
feature is as appealing: The chair lifts onto two
wheels so that its occupant, although still sitting, is
elevated enough to
reach high bookshelves and carry on eye-level conversations
with people standing nearby.
"One reason I built it was to let people stand up," said Kamen,
who licensed the iBOT to Johnson &
Johnson. "We treat a lot of adults like
children because they can't stand up."
"I wanted to take it home and keep it," said Karl Barnard of
Tilton, N.H., who tested the iBOT in
a study required by the FDA, which regulates wheelchair
safety.
In the iBOT, he rose to the height of a 6-foot-tall person to
do his grocery shopping without help. Barnard, who lost use of
his legs 25 years ago, has no stairs
in his home, but was impressed with the four-wheel
drive, which let him roll up hills and through gravel on his
farm, places his manual wheelchair
can't go.
But with a predicted $29,000 price tag, Barnard, 46, calls it
"more a luxury item" that he
probably wouldn't buy until he's too old to push his
manual wheelchair easily.
While several FDA advisers called the chair potentially
revolutionary, they also cautioned it's not for
everyone.
Patients must have the use of at least one arm to operate the
chair, moving it with a joystick and other controls, and so
far it's built only for large
teenagers and adults.
Also, it requires some exertion: Users lean forward or
backward, directing the chair to climb up or down as it senses
and adjusts to the person's center
of gravity. They must hold onto a stair rail to help guide it,
although there is a feature that allows someone else to hold
onto the chair back and assist the more severely disabled on
stairs.
Picking the right patient is crucial for safe use -- someone
who not only is physically capable of handling the iBOT, but
has the right judgment skills to
discern obstacles, such as which hills are too steep to climb
without risking serious falls, said Dr. Steve Stiens, a
University of Washington rehabilitation specialist who uses a
wheelchair.
Sales will be strictly controlled, said manufacturer
Independence Technology, a Johnson & Johnson
subsidiary. Doctors and rehabilitation therapists must
undergo special training to prescribe the iBOT, and
potential users would have to pass a test proving they can
drive it safely before taking it
home.
To prove iBOT works, 20 wheelchair users test-drove it for two
weeks, allowing scientists to
compare maneuverability, falls or other problems to
their regular wheelchairs. They also took a road test,
scooting up hills and over bumpy
sidewalks, crossing curbs, reaching shelves and climbing
stairs.
The patients performed most of the challenges more easily with
the iBOT, said study leader Dr. Heikki Uustal of New Jersey's
Johnson Rehabilitation Institute.
For example, everyone had to ask for help to reach a book atop
a bookcase while in their own chairs, but merely pushed
a button on the iBOT to slowly rise and reach it themselves.
Twelve patients could navigate stairs alone with the iBOT,
while the rest used an assistant. In
regular wheelchairs, two patients could literally
bump their way down stairs, but no one could go up a
single step.
Three people fell out of the iBOT and two fell out of their
own wheelchairs during the study,
suggesting the iBOT is as safe as today's
technology.
The iBOT's $29,000 tab is less than some top-of-the-line
models for the severely impaired, but far more than basic
chairs. But Independence Technology
President Jean-Luc Butel said the average cost for ramps,
elevators and other home modifications for someone unable to
walk is $40,000, expenditures largely
unnecessary with the iBOT. He is negotiating with
Medicare and other insurers to pay for the iBOT.
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