Dissertations / Theses on the topic 'Wheelchair and seating provision'

High-tone extensor thrust is common to those with cerebral palsy and those suffering spinal cord injuries. It is a muscle-control phenomenon that causes the body to straighten spastically. One goal of this thesis is to design a dynamic seating system that moves with respect to the wheelchair frame, allowing the seat to move with the user during an extensor thrust and reduce forces. One unique challenge is that the seat needs to remain rigid during normal functional activities and only become dynamic when an involuntary thrust is detected. A second goal of this thesis is to design a control scheme that is able to differentiate between these two types of motion. These design goals are initially investigated with a hinged-seatback system, instrumented with sensors to allow for the detection of thrusts and to actively control seating components. A full seating system is then built to allow for full-body extensor thrusts, involving the seatback, seat bottom, and leg rest of the wheelchair. This system is analyzed for effectiveness of reducing forces on the body during an extensor thrust. Another serious problem for this segment of the population is pressure ulcers. These are caused by prolonged pressure on the skin from weight-bearing bony prominences. Various seating system configurations are known to help with pressure relief. The three standard configurations for a chair are tilt, recline, and standing. The final goal of this thesis is to measure and compare the effectiveness of these three methods for their ability to relieve pressure on the seat bottom. To accomplish this, a powered wheelchair with built-in capabilities for recline and standing is mounted to a tilting mechanism. Test subjects are used to experimentally compare the effectiveness of each method for pressure reduction using pressure mats on all weight-bearing surfaces. A 2D model is also developed and validated with the experimental results.

For decades the care of disabled population in Brazil has been neglected by the government and was provided largely by the charitable institutions. It was as only recently, as in the year 2011 that Brazilian government created the national plan for the rights of the disabled people. The plan articulates policies regarding social inclusion, access to education, accessibility and health care. The last section of the plan includes the provision of wheelchairs free of cost to the Brazilians citizens, who are in need of a wheelchair. It is common knowledge that a wrong wheelchair specification can lead to physical damage for the user and the carer; the abandonment of device, and wastage of time and resources involved in the wheelchair provision. The World Health Organization has propounded several good practices and training material with reference to wheelchair services towards enabling of right wheelchair fit to the user characteristics. Though, there is no evidence that the service provided in Brazil adheres to these guidelines or any other wheelchair service good practice. This research reviews the wheelchair service provision in Belo Horizonte city, Brazil with the aim to understand the functionality of these services in order to provide context-specific interventions and recommendations to improve the design of current services. Herein, three main studies were conducted using a mix of methods: A first exploratory study was conducted to assess the Belo Horizonte assistive technology services and identify a research focus. A second study was conducted to develop an in-depth insight on the understanding of the wheelchair service provided and to collect the necessary information towards creating a context-based and collaborative designed intervention. A third study was conducted to evaluate and improve the proposed interventions. A total of sixty-six interviews were conducted (n=66) with service stakeholders and two hundred and fifty user care observed (n=250) from which ninety-five (n=95) tested the proposed interventions.

Esta dissertação consiste em um estudo teórico exploratório sobre o projeto sistemático de sistemas de assento especiais para cadeiras de rodas, com ênfase em seus aspectos conceituais e funcionais. De acordo com os princípios da tecnologia assistiva - que consiste no uso de tecnologias para o atendimento das necessidades de pessoas com deficiência - o objetivo das ajudas técnicas deve ser a promoção da atividade e participação social através da compensação de deficiências, promovendo a funcionalidade. Assim, foi feita uma revisão da literatura a respeito da adequação postural do usuário de cadeira de rodas, e dos fatores que contribuem para sua saúde, sua funcionalidade e seu conforto ou desconforto na posição sentada, permitindo a identificação de suas necessidades explícitas e implícitas. Com o uso da Metodologia de Projeto Sistemático de Pahl e Beitz, da Metodologia de Projeto Axiomático e da Teoria da Solução dos Problemas Inventivos (TRIZ), foi elaborada uma lista de requisitos funcionais através do mapeamento entre o domínio das necessidades do usuário e o domínio funcional do sistema de assento. Em seguida, elaborou-se uma estrutura funcional, demonstrando os principais elementos e conexões funcionais do sistema, sendo por fim comentados e propostos alguns princípios de solução para cada uma das sub-funções principais encontradas, envolvendo a análise de princípios de solução de sistemas existentes e de sistemas análogos em outras áreas tecnológicas. Concluiu-se que a imobilidade é o fator primário que desencadeia os diversos problemas de saúde e funcionalidade do usuário associados ao uso destes sistemas de assento, e que portanto a função principal desses sistemas deve ser a de permitir, facilitar e promover positivamente a alternância freqüente de posição. Além disso, verificou-se o papel fundamental dos fluxos de informação responsáveis pela determinação do propósito homeostático da movimentação, que objetiva a redistribuição contínua das tensões locais nos tecidos, além do favorecimento da ação motora voluntária pela estabilização e mobilização seletiva de movimentos corporais.
This work is an exploratory theoretical study on systematic design of special wheelchair seating systems, emphasizing its conceptual and functional aspects. According to the principles of assistive technology - which consists in the use of technologies applied to the caring of the needs of people with disabilities - the objectives of technical aids should be the promotion of optimal individual functionality. Thus, a literature review has been made on the theme of postural seating clinic, and the factors related to the health, the functionality, and the comfort or discomfort in the sitting position, allowing the identification of many explicit and implicit needs. By using the Systematic Design approach of Pahl & Beitz, complemented by some principles of Axiomatic Design and TRIZ, a functional requirements list has been made, consisting in the mapping between the customer needs in the customer domain and the functional requirements in the functional domain. In the next step, a functional structure has been created, showing the main functional elements and connections of the seating system, followed by the proposal of some working principles regarding the main identified sub-functions, including the analysis of analog technical systems of other technological fields. It was concluded that immobility is the main causative factor leading to the many functional and health problem associated with the sitting position, and therefore the main function of special seating systems must be to allow and actively promote frequent position changes. Moreover, it has become evident that information flows have a capital importance in proper functioning of seating systems, since they convey the homeostatic purpose of the movements being made, in order to continually redistribute and alleviate the local soft tissue deformations, and to promote the selective stabilization and motion of body segments that permit functional motor action.

The aim of this PhD research is to explore English football stadia provision for spectators who are wheelchair users, identifying features that can limit, or which can promote their inclusion. The outcome of the research is to provide a fuller understanding of what can constrain or enhance provision for spectators who are wheelchair users and to propose strategies that can enhance inclusive stadia provision. Various bodies of knowledge are brought together and applied to football stadia in order to: 1. Assess the design process, the legislation, the building regulations, the guidance and how they meet the needs of wheelchair users; 2. Examine the inclusivity of spectator sports and appraise the design guidance for stadia that can facilitate access to them; 3. Investigate the everyday user experience when attending football stadia and understand how provision is determined in practice; and 4. Recommend the changes and improvements that need to be made so that wheelchair users are better accommodated in football stadia. This qualitative research adopts an open-ended inductive approach, with some deductive aspects (namely, the critical literature review that initially led to the research). Semi-structured, in-depth interviews were conducted to capture (i) the everyday experiences of twenty disabled supporters who are wheelchair users and (ii) the perspectives of eight key stakeholders involved in football commerce, stadia design and stadia management. The key findings revealed that English football stadia have many physical, attitudinal, management and operational barriers that limit accessibility for spectators who are wheelchair users; and that there are many constraints in design practice that have limited the inclusion of wheelchair users in English football stadia.

Seeking pupils' views became an issue of national importance following legislation (Section 29A of the Education Act 2002, CRAE, 2008) and lack of such consultation in the United Kingdom has been repeatedly raised by the UN Committee on the Rights of the Child (1995,2002 and 2008). The importance of seeking the views of all children about their experience is particularly salient since there is a legacy of exclusion and disadvantage for disabled children in mainstream school settings and provision historically has been planned and developed for them, without consulting with or involving them directly. This study investigates the views and experiences of ten disabled pupils who attended a resourced provision attached to a mainstream secondary school. It used semi-structured interviews within a social constructivist paradigm carried out with disabled teenagers by a disabled researcher. The transcriptions of the interviews were analysed thematically with the categories for the analysis developed by grounded theory. Detailed consideration was given to the ethical issues raised by research which focuses on the need to promote the engagement of the children and ensure their voice is heard and these issues were addressed in the context of the present study. The evidence from this study indicates that the pupils welcomed the opportunity to talk to a disabled researcher and were willing to explore their experience of being a disabled pupil in the school. They reported issues around transition to the secondary school with the resourced provision, feeling `forced away' from their local community and from friendships established in their primary schools. They commented on bullying in the school and feelings of being perceived as `different', as lesser human beings. Most of the children did not take on board the descriptor of `disabled' for themselves, talking instead about their impairments, which they did not see as important to their sense of identity or self. The conclusions reached stressed the need for teachers and policy makers to listen and respond to pupils' voice, taking into account individual needs, and engaging in joint problem solving with pupils at both an individual and systemic level. They need to be reflexive in their practice to avoid discrimination and support all children's rights and there should be increased awareness of the affirmative model of disability - we are valued for who we are, our disability is part of this and so our predicament and how we manage it should be accepted and valued as well.

博士
國立成功大學
生物醫學工程學系
103
Elderly adults with lower limb disorders sitting on a wheelchair for an extended period of time may experience numerous complications. Critical complications in clinical practice include back pain, pressure ulcers, and decreased pulmonary function. Wheelchair seating system is a key factor that influences spinal angle, back muscle activation, interface pressure, pulmonary function, and subjective discomfort. Although numerous studies on wheelchair seating systems have been conducted, it seems that the aspect of aforementioned problems can still be further improved. For reduce the risks of back pain, pressure ulcers, and decreased pulmonary function in wheelchair sitting posture. This study proposed a novel wheelchair seating system concept: the backward thoracic with upward femur support seating system. The purpose of this study was to evaluate the spinal angle, back muscle activation, interface pressure, pulmonary function, and subjective discomfort when using the backward thoracic with upward femur support seating system in the elderly population. Twenty elderly people were recruited for this study. the backward thoracic with upward femur support sitting (TF) was compared with the relaxed slouching sitting (RS), flat back support sitting (FB), prominent lumbar support sitting (PL), and backward thoracic support sitting (BT). Spinal angle (thoracic, lumbar, and pelvic angles), back muscle activation (maximal voluntary isometric contraction of the thoracic erector spinae at T9, iliocostalis lumborum pars thoracis, lumbar erector spinae, and lumbar multifidus on both sides), interface pressure (total contact area, average pressure, and peak pressure on backrest and seat), pulmonary function (forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow), and subjective discomfort (neck, shoulder, upper-back, mid-back, lower-back, upper-arm, lower-arm, buttock, thigh, and leg) were measured and compared. The results of spinal angle measurement: the TF showed relatively higher thoracic kyphosis and lumbar lordosis when compared with the RS, FB and PL, no significant difference when compared with the BT; and it also showed a relatively neutral pelvic tilt when compared with the RS and LP, no significant difference was observed when compared with the FB and BT. The results of back muscle activation measurement: the TF showed relatively higher back muscle activity when compared with RS and lower back muscle activity when compared with the FB and PL in all tested muscles, no significant differences when compared with the BT. The results of interface pressure measurement: the TF showed relatively higher total contact area, average pressure and peak pressure on backrest when compared with the other sitting postures; and the BT showed relatively lower average pressure and peak pressure on seat when compared with the other sitting postures; nevertheless, the TF showed relatively lower total contact area, average pressure, and peak pressure on the back part of seat and higher total contact area, average pressure, and peak pressure on the front part of seat when compared with the BT. The results of pulmonary function test: the TF showed relatively higher pulmonary function values when compared with the RS, FB, and PL in all tested parameters, no significant differences were observed when compared with the BT. The results of subjective discomfort evaluation: the TF showed relatively lower subjective discomfort in upper-back, mid-back, and lower-back when compared with the RS, FB, and PL, no significant difference when compared with the BT; and it also showed relatively lower subjective discomfort in buttock and higher subjective discomfort in thigh when compared with other sitting postures. The backward thoracic with upward femur support seating system concept was suggested because it maintains an increased lumbar lordosis with rather neutral pelvic tilt, decreased back muscle activation, diminished pressure on the ischial tuberosities, improved pulmonary function, and lessened subjective discomfort in back and buttock which may help maintains a better wheelchair sitting posture for reduce the risks of back pain, pressure ulcers, and pulmonary function decline. The achievements of this study contribute to the decision-making processes of wheelchair seating systems for consumers, clinicians, and manufacturers.

碩士
國立成功大學
醫學工程研究所
87
Abstract Following with the melioration of medical and engineering technology, its to attach importance to welfare and living quality of deformity; The ultimately purpose of rehabilitated medicine is to improve the functional development of deformities. In Taiwan, the cerebral palsy have often developmental delay, deformity, and functional disabilities resulting from abnormal muscle tone, reflex and impaired sensory system. Early intervention for C.P. initiating from 2 to 3 years old, who have received early rehabilitation treatment, seating and body supports with assistant technology as well as long-term training and education, has demonstrated to provied promising outcomes in significantly improved abnormal muscle tone, reflex, bodys coordination and balanced control. Unfortunately, there is lack of assistive technology service program to provide systematical clinical evaluation and prescription of specialized seating / positioning support systems for the neuromuscular impairment in Taiwan. In addition, the fields of rehabilitation technology/assistive devices are very new with little R&D. This project is to design specialized seating/positioning wheelchair for the cerebral palsied. The goal is to provide clinical effective seating supports for minimizing abnormal muscle tone and reflex, and to improve balance control, movement coordination and functional activities for the cerebral palsied. This project select 93 cerebral palsied, measuring the anthropometric data of optimized seating position. Using Multivariate Cluster Analysis to divide subjects into two clusrters, according to ages 2~8 and 9~26. Then using Univariate Regression Analysis to predict the range of anthropometric data in which two clusters. In order to target the modular dimension of the wheelchair main structure, therefore to follow the example of case numbers, to select in each division and to decide the standard dimension of seating anthropometric, at the same time to transfer variance into wheelchair’s main structure and to proceed conceptual design. The project using AutoCAD to draw wheelchair dimension plane and three-D conceptual drawing. Using spacilized CAD/CAM software Pro/Engineer to simulate actual wheelchair specification and to compute the center of gravity position and inertia tensor of wheelchair structure. The results of this project indicate that the center of gravity position locate upon the center axis of cross bar, underscoring the seating system. Conforming to safety designing condition; the next, in all direction of inertial tensor respect to wheelchair are greater than tensors of plane. It means that the motion of wheelchair will be slower when it turning around. In the other hand, it will be more laborions when family members moving wheelchair. In view of obvious variabilitiy between each cerebral palsy. The design of individual seating and positioning wheelchair must to be base on biomechanics, posture controling, neuropathology, human factor engineering, to investigate objective clinical evaluation, to provide effective personal deficient device. Final destination of this research are (1) Keeping normal posture control and bring to maximum regular function. Promoting the patient independent ability. (2) Providing clinical training and collecting the data auxiliaryequipment(3) Training engineers to design and manufacture seating and positioning body support. (4) Shifting technology to medical treatment system. Developing science and technology about auxiliaryequipment.

碩士
國立成功大學
醫學工程研究所
89
In addition to medical and rehabilitative treatments, seating/positioning is important to the individual with central nervous deficits, particularly for moderate or severe cerebral palsied (CP) children. It has been reported statistically in Taiwan that 0.6 to 5.9 per 1,000 children are affected by CP. Proper seating and body support devices are useful in normalized muscle tone, decreasing the influence of pathological reflex and improving body stability and movement for preventing deformities, developmental delays and functional disabilities from their life span. This research purpose was to develop a modular design of specialized wheelchair (WC) and support systems for effectively customized fitting the individual’ seating/positioning needs, and for minimizing the product design and manufacturing cost. More specifically, this research was to: (1) develop and establish modular parameters of mechanical structure, mechanics and components for the design specification of specialized WC and body support system; (2) apply CAD/CAM and finite element method (FEM) for mechanical design, stress and strain analysis of structural and mechanic components, and manufacturing of modular products. The modular design of seating/positioning devices has been motivated from wide variations of age, body sizes, neuromuscular impairments and functional support needs for the CP population. The seat width and depth, backrest height and leg length, seat and back angles, and other components’ dimensions in linear and angular ranges need to be considered in the design of specialized WCs with foldable, anti-tip and braking functions. The design of body supports needs consider the size, shape and fitting location of head and trunk supports, H hardness and safety belts, abductor and tray. In Stage I, the main structural parameters of WC’ seat width and depth, backrest height and legrest length for modular design specifications were determined from Average Linkage and K-means methods of multivariable cluster analysis on the anthropometrics data measured and collected from 140 CP cases (ranging from 2 to 25 years old). The dimensional ranges of other components and body support systems were also statically determined from the subject’ database for modular design specifications. In Stage II, SolidWorks packages with constructive solid geometry of pipe, beam and shell components and triangular elements of FEM with strength analyses of maximum shear stress criterion were used for CAD design and stress-strain analysis of the structural and mechanic components and modular parts of the special wheelchair with A6061T6 aluminum alloy tubing and plate. In Stage III, CAM was used for the manufacturing and dies molding and assembly of the modular design products. The R&D has completed 3 prototype design modules of large, medium and small folding and reclining WCs equipped with anti-tip and brake devices for safety, the dimensional options include: 25.4, 31.8 and 41.4cm for WC width; 18, 21, 26, 31, 36, 41, 47, 51 and 56cm for both WC depth and backrest height; 15, 21, 27, 33, 39 and 44cm for legrest length; 5, 8 and 12 for seat angle; 75, 85 and 95mm in radius curve for head support; 40 and 65mm height for trunk support; and 60, 80 and 100mm width for abductor. All parts and components are easily inserted and removed adjustably to fit each individual needs. A seating/positioning protocol has been developed for clinical evaluation, measuring, prescription and fitting of the specialized WC and body supports. Fifty cases with severe cerebral palsy have been prescribed and fitted with their appropriate WCs and supports with the assembly of developed modular components according to their individuals’ needs. This pilot field testing of clinical application has demonstrated that the modular design of wheelchair and seating/positioning supports is useful to provide effective mobility aids, normalized muscle tone, body alignment and postural control , and to improved the influence of reflex, body coordination, balanced and movement, and functional abilities. The『Modular Design』seems to be highly applicable to satisfy widely varied seating/positioning needs for the CP, SCI, Strokes, TBI, MD and MS. In addition, the design and manufacturing process can be achieved with significantly minimized the product cost for wheelchair industries. Further clinical studies for application outcomes need to be investigated.

The limited customisation in commercially available wheelchairs does not always appropriately accommodate the anthropometric variations resulting from specific impairment. Wheelchair racing athletes demonstrate up to 3.8% total body mass greater in the upper extremities, and up 9.8% total body mass reductions in their lower extremities, and between-limb asymmetries of 62.4%. As a consequence, athletes may not have the stable base of support required for optimal propulsion. The optimisation of an entire wheelchair to match unique athlete geometry is both time consuming and costly, as wheelchairs cost over $2000 each. The use of assistive technology can provide an efficient transition between the commercially available equipment and the unique athlete anthropometry. Customised seating interfaces offer a time and cost effective solution, facilitating regular modifications to satisfy athlete growth. These solutions have been used extensively in clinical applications for enhanced stress distribution and injury prevention at the seating interface; however, they have not yet been applied to sporting contexts. The goal of this research was to investigate the performance impact of customised seating interfaces on wheelchair racing propulsion technique. Supplementary goals included the development of practically viable instrumentation solutions and a musculoskeletal model representative of the unique wheelchair racing athlete anthropometries and physical capabilities to assess injury risk to analyse performance impact holistically. The research was split into four main themes: 1. Verification of the importance of the seating interface relative to other key performance parameters such as aerodynamics and glove selection. 2. Instrumentation of the hand-pushrim and seating interfaces 3. Development of a musculoskeletal model 4. Computational modelling of performance and injury risk Computational modelling was performed in the OpenSim environment which coupled kinematic inputs from 3D motion capture (VICON Bonita V16; Oxford Metrics, Oxford, United Kingdom), with kinetic inputs from a pressure mat at the seating interface (XSensor LX100; Calgary, Alberta, Canada) and inertial measurement units (IMUs) (I Measure U; New Zealand) to estimate the hand-interface interactions. This was achieved using Newton’s Second Law, incorporating athlete-specific mass data (from the analysis DXA scans), and acceleration measured from the IMU. Customised seating interfaces reduced the undesirable peak translations of the knee by up to 41.8% and lateral translation of the spine by 33.4%. These translated towards enhanced performance, with an average performance time reduction of 29.8 s (3.7% race time) in the eight international competitions following the inclusion of the customised seating interface. Additionally, athletes using cushioned seating interfaces had reduced peak pressures at the seating interface as compared to those without the interface. Instrumentation can be used outside the laboratory environments, and can, therefore, be applied in the daily training environment to optimise performance preparation. This research provided foundation work for the use of computational biomechanical analyses for the holistic assessment of wheelchair racing performance. Whilst this research has demonstrated the potential impact computational modelling approaches can have on the performance preparation of athletes, some areas for further refinement have been identified. Future research into the processing of IMU data and the validation of musculoskeletal models for wheelchair racing athletes are the critical areas for improvement. Once achieved, the computational modelling approaches explored in this research can positively impact performance outcome, particularly when coupled with the optimisation of equipment, such as customised seating interfaces.
Thesis (Ph.D.) -- University of Adelaide, School of Mechanical Engineering, 2019

Participants in the author’s training program for OT practitioners who work in skilled nursing facilities will gain an understanding of the need and requirements for ongoing wheelchair seating and positioning management of long-term care residents. BACKGROUND: Elderly individuals admitted to a skilled nursing facility receive initial occupational therapy (OT) evaluation for appropriate wheelchair (WC) seating. On extended stay, the resident’s seating needs often change, leading to postural impairment from improper positioning. Lack of awareness of poor positioning by residents, particularly when cognitive issues are present, can delay corrective action because they may not call attention to difficulties or discomfort. Occupational therapy practitioners (OTPs) can play a distinctive role in ensuring that proper wheelchair seating and positioning of older residents is maintained. The author’s aim is to create a prototype program designed to mitigate the risk that accompanies poor wheelchair positioning and that can be carried out at any skilled nursing facility (SNF). OBJECTIVES: The author’s project will address the recognized need for a training program for occupational therapy practitioners that will provide guidelines for assessing, evaluating and planning the appropriate intervention for an elderly manual wheelchair user in a skilled nursing facility. Objectives for the resident include reduction in the incidence of wound development, improvement of functioning, and increase in participation in the care environment with other wheelchair users. METHOD: Program implementation will begin with facility recruitment. The author will create a handout illustrating the planned program and will distribute it in person or via mail to administrators of skilled nursing and residential care facilities within a 100-mile radius that have a rehabilitation department and one or more OT practitioners. When interest is expressed by a recipient, the author will contact the facility and conduct a short interview to discuss problems and concerns, the availability of staff incentives for participation in inservice training, and payment for the author’s services. Depending upon the author’s assessment of participant knowledge, skills and needs, training will be adjusted from an introductory to intermediate level. As part of the proposed program, the author will recommend that OT practitioners instruct nursing and other caregiving staff to periodically screen every wheelchair-dependent resident when they are providing direct care during their daily routines. Miller, Miller, Trenholm, Grant and Goodman (2004) developed the Seating Identification Tool (SIT) to fill the need for an easy to administer screening questionnaire that would be sufficiently sensitive for clinical assessment and research. ANTICIPATED FINDINGS: Occupational therapy practitioners will play a distinctive role in ensuring that proper wheelchair seating and positioning of older residents is maintained. Preventing pressure ulcers will prove to be much less costly than medical treatment, both to the resident and the facility. Reduction in time lost from daily occupations to allow healing will improve the client’s sense of well-being. OT practitioners will be called upon to make periodic adjustments in wheelchair fitting and positioning, which might as simple as providing an appropriate wheelchair cushion. LIMITATIONS: Program development and program evaluation research are in the initial stages and have not yet been implemented in any skilled nursing facility. RECOMMENDATIONS: The author recommends implementation of the pilot program in a skilled nursing facility with data gathering for program evaluation research to gain evidence and further refine the program.

In British Columbia (BC), people with developmental disabilities, including those with severe physical impairments, have left institutions to live in supported homes in the community. Services traditionally provided in the institution, up until final closure in 1996, are now provided in community. One of the necessary, specialized community services identified during the final deinstitutionalization phase from 1990 to 1996 was therapeutic wheelchair positioning or 'seating'. In 1996, a study was contracted by the Transition Steering Committee (TSC), a group responsible for ensuring the availability of services in the community for persons leaving institutions. The study defined the need for seating services, determined client and therapist preferences and reviewed existing seating resources, in order to develop a workable service delivery model for adults with developmental disabilities in B C . The model conceived in 1997, but never implemented, was that of a boundaryless service network termed the British Columbia Seating Network (BCSN). In order to understand the context of community living service development for this population (including barriers to implementation of new programs) as well as to confirm that the proposed model of service delivery still satisfied the prospective users of the BCSN, qualitative investigative activities were undertaken. Following from the research of the original project, three key stakeholder groups were identified - consumers, community therapists and provincial government administrators. The perspective of the consumer was investigated through an interview with the executive director of the British Columbia Association for Community Living (BCACL); community therapists attended focus groups; and relevant government administrators, including members of the TSC, were interviewed about the deinstitutionalization experience in B C , as well as the status of evolving community living services, including the proposed BCSN. Results indicated that, while most participants believed that deinstitutionalization had been an overall success, there were many challenges facing community living services, and the determinants to success or failure were often political in nature. Participants collectively praised the BCSN, yet analysis of findings indicated that the model was ultimately doomed to failure because of poor timing, lack of profile or of a champion, an all or nothing approach which encompassed a preference for generic over specialized service, sustainability, the tenuous relationship between research and policymaking, the destabilizing effect of change, as well as other influential aspects of the political decision-making process during the final stages of deinstitutionalization. Other themes which arose out of the findings included the fear of reinstitutionalization, the lack of planning for aging in place and for new users of community living services, and the pivotal and evolving role of interest groups. Finally, a future focus for stakeholders in community living in B C was articulated as ensuring that families in community would not be forgotten because the high profile that deinstitutionalization had given persons with developmental disabilities was gone. It was concluded that the B C S N was the right model, but that political barriers had ultimately prevented implementation, and that all stakeholders in community living need to be aware of the multiple and complex influences contributing to decision-making around the development of health services for persons with developmental disabilities.