Anthropometry of Indian Manual Wheelchair Users: a validation study of Indian accessibility standards - Vikas Sharma, Access Consultant, AccessAbility,

India Statement of Problem There are several accessibility guidelines in India that provide slightly differing anthropometric standards and design recommendations. However, it is unclear whether any of the standards available are based on original anthropometric research done on the Indian disabled population. Despite advancements in assistive technology and increasing availability of customised wheelchairs, there has been no study to validate the Indian accessibility standards and to check if they continue to meet the functional anthropometric needs of Indian manual wheelchair users. Objective The overall aim of the study is to establish whether the Indian accessibility standards continue to meet the anthropometric needs of the current population of manual wheelchair users. This will identify if a need for further research in the anthropometrics of Indian disabled population or a review of the existing accessibility codes is indicated. Methodology The study aims to review the existing literature to analyse the current anthropometric recommendations in the Indian accessibility standards and guidelines and also compare these with the corresponding publications produced by the International Organisation for Standardisation (ISO) and those in use in UK and USA. It is intended to investigate if the Indian standards were based on any original anthropometric research done on the local population of Indians with disabilities. Static and Dynamic anthropometric data of a sample group of 15 Indian manual wheelchair users will be collected during the study to identify the design needs of the current population. These findings will then be compared with the existing Indian standards and a critical analysis done. Summary of Literature Review Person with Disabilities Act (1995) is a landmark legislation that recognises the rights of Indians with disabilities and creates opportunities for equal participation in all government run infrastructure and services. There are several access standards and guidelines published by the different departments of the Government of India but the Act does not comment on them and does not endorse any particular publication. Table: Indian Accessibility Standards and Guidelines Name Developed by Published Revised Enforcement IS 4963: Recommendations Bureau of Indian 1968 1992 Standard for Buildings and Facilities Standards (BIS) for the Physically Handicapped

National Building Code IS 7454: Rehabilitation Equipment-Wheelchairs, Folding, Adult Size Specification Guidelines and Space Standards for Barrier Free Built Environment for Disabled and Elderly Persons Planning a Barrier Free Environment

BIS BIS

1970 1974

2005 1997

Standard Standard

Central Public Works Department (CPWD)

1998

1998

Guideline

New Delhi Building Byelaws

Office of Chief Commissioner for persons with disabilities (CCD) Delhi Municipal Corporation

2001

2001

Guideline

2005

---------

Standard

The following tables illustrate a comparative analysis of Guidelines and Standards for accessible design used in India, UK and USA. Also comparison has been done with the standard ISO 7193: Wheelchairs - Maximum overall dimensions and ISO/ TR 9527: Building Construction Needs of disabled people in buildings Design guidelines published by the International Organisation for Standardisation. For USA Americans with Disabilities Act Accessibility Guidelines (ADAAG) were reviewed whereas for UK, BS 8300: Design of buildings and their approaches to meet the needs of disabled people Code of practice and Inclusive Mobility, which are accessibility guidelines produced by the Department of the Environment, Transport and the Regions (DETR) were included in this study. The analyses was limited to wheelchair dimensions, clear floor area provisions, space requirements for maneuvering, knee and toe clearances and reach limits. The columns in light green background represent the Indian anthropometric recommendations and the columns in lavender background represent the international ones. Figures in red indicate exact matches and figures in blue indicate close similarity between the Indian and international access standards and guidelines. The various exact matches and several close similarities for the dimensional data clearly hint that the Indian recommendations may be a negotiated settlement of international minimum guidelines and requirements. Table: Comparison of Structural Anthropometry of wheelchair users (in mm) Country India UK USA ISO Standard BIS (IS CPWD CCD Inclusive ADAAG ISO 7454 & IS Mobility 7193 4963) (DETR 1999) & ISO & BS 8300 9527

Wheelchair Measurements Unoccupied width 650 720 Occupied width X Unoccupied length Occupied length Handle height Eye height Total seated height Armrest height Seat height 10001100 X 910 950 X X 700 740 480 510

750 800 1050 1200 X X X X X X X X X 350

680 900 1200 1150 1250 920 1100 1300 X 760 480 500 675 200 X X 480

750 800 1200 1250 X 960 1250 1300 1400 794 460 490 691 X 260 X 490

660 760 1065 1220 915 1090 1295 X 760 485 685 205 280 150 X

700 800 900 1200 1250 1090 X 1350 X 500 X X X X 600

Knee height X Toe height X Knee clearance depth X Toe clearance depth X Combined knee + toe 400 clearance depth 450

Table: Comparison of Functional Anthropometry of wheelchair users (in mm) Country India UK USA ISO Standard BIS (IS CPWD CCD Inclusive ADAAG ISO 7454 & IS Mobility 7193 4963) (DETR 1999) & BS 8300 Reach Ranges Forward High 1350 1200 1200 X 1220 1200 1600 Low X 400 400 X 380 400 Obstructed high 715 - 830 1100 1100 1000 1150 1120 X Obstructed low X X X 650 X X Reach Ranges Lateral High 1350 1300 1300 1060 1170 1370 X 1770 Low X 250 250 630 665 230 X Obstructed high X 1200 1200 X 1220 X Maneuvering Clearances Width 90 L-turn X X X 1450 - 1550 915 X Circular diameter 1500 1500 1800 1600 - 2150 1525 1500 2000 360 turn

Review of research behind developing the standards reveals that the Indian standards, except IS 7454, and accessibility guidelines are not based on any original anthropometric research done on the local disabled population. The Indian Standard IS 7454 was based on research done on static anthropometry of unoccupied wheelchairs in late 1974. Advances in wheeled mobility technology, the ongoing demographic shift towards an ageing society, and changes in stature of the population due to nutritional improvements and genetic shift since that time suggest that the Indian standards may be out of date. Recent research on the anthropometry of wheeled mobility users has been conducted in Australia, the United Kingdom and Canada. Most of these countries have already revised or are revising their standards based on that research. Unfortunately no similar anthropometric research has been done in India to establish needs of the present population. There are a number of studies on basic anthropometry of people with disabilities and of the elderly. Most of these have relatively small sample sizes (under 100), which make it difficult to generalize to a whole population for design purposes. Some have larger samples, but are not from Indian populations. Still others have adequate sample sizes, but have dimension lists that are focused on specific applications such as ergonomics for workplace design, so the usefulness of the resulting data base in terms of designing inclusive environments is restricted. The range of wheelchairs in use in India includes tricyles and caster-carts which have ingeniously been designed to resolve local cultural needs. A lack of anthropometric study of these devices, despite their popularity, has led to poor representation of the needs of their users in the present Indian accessibility standards and building codes. The review of existing literature indicates that there has been no anthropometric research to verify the effectiveness and validity of the Indian accessibility standards. To date, the majority of wheelchair research stems from research groups based in western countries and obviously is directed towards populations of users and wheelchairs in predominantly western countries and their environment. As such, apart from the works of Chakrabati, Mukherjee et al and Goswami et al, little research is available that addresses specific non-western populations of users or wheelchairs. Owing to differences in anthropometry among user populations and among populations of wheelchairs studied, the application of anthropometrical data from wheelchair research originating from studies in western countries will therefore be limited for the specific Indian environmental context. This stresses at least part of the importance of the much needed local anthropometric research in India. Summary of Findings from Anthropometric Field Study The data collected from the field study was compared with the anthropometric recommendations in the various Indian accessibility standards and guidelines. The following tables compare this study with the Indian Standard IS 4963: Recommendations for Buildings and Facilities for the Physically Handicapped (1987, Reaffirmed 1992), Indian Standard IS 7454: Rehabilitation Equipment - Wheelchairs, Folding, Adult Size

Specification (1991, Reaffirmed 1997), Central Public Works Department (CPWD) publication Guidelines and Space Standards for Barrier Free Built Environment for Disabled and Elderly Persons (1998) and the accessibility guidelines Planning a Barrier Free Environment published IN 2001 by the Office of Chief Commissioner for Persons with Disabilities (CCD). The last column in the following tables highlights significant difference between the data collected during the field study and the Indian Standards IS 7454 and IS 4963. Although the CPWD and CCD accessibility guidelines have been included in the comparative tabulation but only the recommendations from the Standards have been used for purposes of the last column. a) Static Anthropometry The following tabulated comparison indicates several significant differences between the recommendations of the Indian standards and the anthropometric data collected from the field study. Major variations were noted in the handle height, armrest height, seat height and the combined knee and toe clearance recommendations.

Standard

Unoccupied width Unoccupied length Handle height Armrest height Seat height

Table: Summary of Findings: Static Anthropometry Field Study IS CPWD CCD 7454 Min 5th 50th 95th Max %ile %ile %ile Wheelchair Dimensions 575 592 642 670 670 650 750 680 720 925 935 1027 1139 1160 1000 1050 1200 1100 885 888 918 974 985 910 X 920 950 690 700 728 759 770 700 X 760 740 495 495 539 591 605 480 X 480 510 500

Significant Difference

* * *

Occupied width Occupied length Eye height

645 980

666 983

User Measurements 734 828 860 X 1112 1246 1260 X

800 1200 X

900 11501250 1100 1300 X 675 200 480

1030 1065 1141 1208 1240 X

Total seated height Knee height Toe height Combined knee + toe depth

1155 1186 1249 1310 1310 X 570 180 265 573 190 279 654 239 359 718 301 448 725 305 455 X X 400 450

X X X 350

b) Functional Anthropometry The most significant differences between the recommendations in the Standards and the data collected from the field study were in the High Reach ranges, in both the categories i.e. forward and sideways, and also the 360 degree maneuvering clearances.

Standard

Table: Summary of Findings: Functional Anthropometry Field Study IS CPWD CCD 4963 Min 5th 50th 95th Max %ile %ile %ile Reach Ranges - Forward High 830 886 1158 1449 1470 1350- 1200 1200 1600 Low 290 297 427 574 595 X 400 400 Obstructed 865 886 1111 1352 1380 715 1100 1100 830 high Reach Ranges Lateral High 920 1126 1331 1496 1510 1350 1300 1300 1770 Low 230 233 289 329 375 X 250 250 Obstructed 860 898 1086 1237 1290 X 1200 1200 high Maneuvering Clearances Width 770 787 950 1134 1155 X X X 90 L-turn Circular 1400 1431 1643 1874 1930 1500 1500 1800 2000 diameter 360 turn Conclusions

Significant Difference

a) Summary of Key Issues The key issues that affect the anthropometry and access needs of Indians with disabilities as identified by this research are as follows:1. None of the standards and guidelines is based on any original anthropometric research done on the local Indian population of people with disabilities. 2. There is no database on functional anthropometry of the elderly Indian population. 3. The structural anthropometric data on wheelchair dimensions in the Indian accessibility standard IS 4963 does not include anthropometry of contemporary wheeled mobility devices such as tricycles and caster-carts. 4. The standards do not provide minimum guidelines and requirements on several essential dimensional variables such as occupied device dimensions, eye height, 90 degree turn width, knee and toe heights and clearance depths, low reach ranges, etc. 5. None of the Indian standards correlate strength with anthropometrics. 6. No validation study has ever been done to check efficacy of the Indian standards.

7. There is poor documentation of the research methodology and sample population studied in the standards and guidelines. 8. Most of the anthropometric design recommendations in the standards have remained unchanged since the first publication. 9. Research results from the field study clearly indicate a variation in anthropometry of wheelchair users from that described in the standards. The deviation is significant in certain variables such as the knee and toe clearance dimensions, seat heights, armrest heights, high reach ranges and 360 degree circular turning diameters. 10. The dimensional data has only been presented as an absolute value, occasionally as a range where only the maximum and the minimum values have been specified. Also, none of the dimensional recommendations have been stratified by the gender type. 11. Anthropometric dimensional data are included in the main document of the standards. 12. Previous studies have only focussed on conventional anthropometry and no attempt has been made to collate a 3-dimensional database to develop computer human modeling techniques. b) Implication of Results An anthropometric database of disabled and elderly population is vital for designing inclusive environments. The present knowledgebase of anthropometry of disabled Indians, as reflected in the standards and guidelines, lacks data on several essential dimensional variables such as occupied device dimensions, eye height, 90 degree turn width, knee and toe heights and clearance depths, low reach ranges, etc. Moreover, there is no database on anthropometry of the elderly Indian population. Also, the exclusion of anthropometry of contemporary rural mobility devices such as caster-carts and tricycles from the standards has not helped in encouraging accessibility in the built environment for the users of these devices. There is poor documentation of definitions of the landmarks and dimensions used in the standards and guidelines. Additionally, there is no mention of the measurement methods used, characteristics of the study population or the sampling techniques employed in the research. A detailed description of the research methodology used and sample population studied enables pooling of data across future studies and also helps in establishing reliability and validity of the study. Strength is a key variable in the ability to complete different functions and should be a significant consideration in functional anthropometry. Unfortunately, Indian standards do not correlate strength with anthropometrics and this severely limits designing of hardware that is easily operable by people with disabilities. There has been no validation study to check the efficacy of the Indian standards and guidelines Moreover, most of the anthropometric design recommendations in the standards have remained unchanged since the first publication. Population demographics

change over time from decade to decade and also the assistive technology keeps evolving. It is, therefore, critical that updates and revisions be made to anthropometric data tables periodically. In the absence of validation studies and any significant revision to the standards it is unlikely that the design recommendations in the standards will meet the needs of the present population. Including anthropometric dimensional data in the main document of the standards makes it very difficult to revise the dimensional recommendations on a regular basis as doing so requires changing the main document of the standards. This may possibly be one of the factors why the much needed changes in anthropometry have not been reflected in the standards. The research results from the field study clearly indicate that the dimensions of a standard wheelchair and the functional anthropometry of wheelchair users vary from those described in the standards. This reveals that the design needs of the present population of wheelchair users are not adequately reflected in the regulatory standards and, therefore, a significant proportion of disabled Indians are likely to find the built environment inaccessible. All the Indian standards and guidelines lack in providing the data in a format that may be useful for designers and policy makers. The dimensional data has only been presented as an absolute value, occasionally as a range where only the maximum and the minimum values have been specified. Moreover, although it is well known that anthropometry varies with gender, none of the dimensional recommendations have been stratified by the gender type. The designers and policy makers need to know the 5th and the 95th percentile values as also the mean and the mode values to enable them to cater to specialist populations such as when designing a rehabilitation centre or an aisle chair for use by disabled people in airplanes. c) Recommendations Guidelines and standards for accessible design are based on data derived from anthropometric research of people with disabilities. This research indicates that the available regulatory and guidance documents in India do not represent needs of the present range of wheeled mobility users. Changes in codes and standards are needed to truly reflect the needs of the local Indian population. Studies of anthropometric needs of wheeled mobility users in rural areas are important and remain to be undertaken as differences in cultural and economic prerequisites must be taken into consideration when representing the access needs of an entire country in the national standards. It is important to study the anthropometrics of tricycles, caster-carts and other contemporary wheeled mobility devices so that the needs of their users may be incorporated in the standards so as to address the reality of local contemporary wheeled mobility use.

Results from the field study suggest that the clear floor areas and seat heights be increased in the standards to address the actual size of wheelchairs in use. Also radical changes are indicated in the knee and toe clearance dimensions, seat heights, armrest heights, high reach ranges and 360 degree circular turning diameters To provide a realistic guidance for designers, information on wheelchair accessibility dimensions should include occupied sizes as well and also include more information on the structural anthropometry of the users. Occupied sizes and user dimensions are most valuable for designers for establishing clear floor area and other space requirements than the unoccupied wheelchair dimensions but the existing standards and guidelines only provide very limited information on these. Other dimensional variables that specifically need to be added to the standards include eye height, 90 degree turn width, low reach ranges, knee and toe heights and clearance depths. There is also a need for studying strength, in its various dimensions and the need to study the correlation between strength and anthropometrics in the accomplishment of activities of daily living in order to design enabling environmental hardware. The anthropometric specifications and dimensional recommendations should be included either in a supplementary document which is not part of the standards or be included in an appendix to the main document. This is crucial as later revisions in the anthropometric recommendations, which will be essential as our understanding of the anthropometrics of disability increases and also as the assistive technology advances, may be incorporated easily without needing to change the main standards. The importance of the much needed local anthropometric research in India can not be over-emphasised. A major nationwide anthropometric survey is recommended to provide specific anthropometric data on the general Indian population of people with disabilities and the elderly across urban and rural India. This will provide the groundwork to support improvements in the accessibility guidelines and standards so that they more accurately reflect the functional abilities and needs of the local Indian population of people with disabilities. Anthropometric studies conducted today will need to address the design challenges of tomorrow and therefore it is essential that anthropometric research is undertaken periodically to review the standards as the assistive technology keeps evolving and the demographics of disability keep changing. Limitations of the Study The sample described in this study was not representative of the Indian wheelchair population in terms of gender, ethnic diversity, wheelchair type and disability type. The field study only included anthropometric research on manual wheelchair users who have been disabled due to spinal cord injury and, therefore, may not necessarily represent the needs of all wheelchair users. Moreover, since the study was conducted in New Delhi, it does not have representation from other geographic areas whereas it is well established that people in the Southern and Eastern states of India have significant anthropometric

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