Disability and the cost of mobility in the urban environment: An experimental outdoor study

Urbanization and the growing demand for accessible infrastructure underscore the need for inclusive urban planning, particularly for individuals with mobility limitations such as wheelchair users. Despite the increasing focus on equitable access, traditional accessibility assessments often overlook contextual elements, such as physical barriers, that can significantly impact mobility. This thesis addresses this gap by analyzing pedestrian spatial accessibility within the x-minute city framework, specifically for wheelchair users in Zurich’s District 1. The study applies three different Floating Catchment Area (FCA) methods — 2SFCA, E2SFCA, and KD2SFCA — to evaluate how methodological choices influence accessibility outcomes for different population groups. The methodology included enhancing the pedestrian network by integrating slope information and key accessibility features, such as stairs, surface conditions, and curb ramps, collected as part of a citizen science project. To further refine the analysis, a survey of 29 wheelchair users was conducted to assess their perception of accessibility features. The responses were used to weight the accessibility features in the enriched network, allowing for a more user-centric analysis. The enriched network was analyzed using the three FCA methods to assess the impact of data enrichment on accessibility evaluations. The results reveal significant spatial accessibility disparities between the general population and wheelchair users. Applying the x-minute city concept with a 10-minute threshold revealed that, while accessible to the general population, wheelchair users experienced substantial limitations caused by physical barriers, demonstrating the importance of incorporating detailed accessibility data. Among the FCA methods, E2SFCA emerged as the most effective in capturing accessibility disparities, particularly for populations with mobility restrictions, as it accounts for distance decay within subzones, unlike the binary approach of 2SFCA or the continuous decay of KD2SFCA. This study advances urban accessibility research by demonstrating the impact of integrating localized data and selecting appropriate methodological approaches. Refining accessibility models based on user needs leads to more precise and equitable evaluations for inclusive urban environments.

As a result of stroke, impairments such as hemiparesis, gait deficits, impaired motor function and physical deconditioning can occur. In which, gait is one of the most important functional limitations and this way the evaluation becomes important to determine the functional profile and consequently to develop an appropriate treatment. The objective of this study was to evaluate and correlate functional capacity with the level of motor and functional impairment in chronic hemiparetic. This is a cross-sectional study using the Six-Minute Walking Test (6MWT) to assess functional capacity and the Fugl Meyer Protocol (FM) to assess the level of motor and functional impairment. Twelve hemiparetic subjects were included. Statistical analysis revealed no significant correlation between the 6MWT and FM. We conclude that the present study revealed a non-correlation between functional capacity and motor impairment in chronic hemiparetic.

Background: Transcutaneous electrical nerve stimulation(TENS) is an effective physiological intervention for people with stroke which aims at reducing muscle spasticity, enhancing muscle strength, and improving motor control and function. In view of the potentials to enhance greater cortical activation of the lesion side by eliciting spare neural pathways through bilateral intervention, this study examined whether the combined use of bilateral TENS (Bi-TENS) and task-oriented training (TOT) was superior to unilateral TENS(Uni-TENS)+TOT, placebo-TENS+TOT and no active treatment to improve the motor impairment of upper limb function in people with stroke. Method: There were 120 subjects with stroke(44 females, mean age=61.52±6.73 years, post-stroke duration=6.04±3.12years) being randomly allocated into 4 groups, including the Bi-group (n=30), Uni-group (n=30), placebo group (n=30) and control group (n=30). Subjects in the Bi-group, Uni-group and placebo group got 60 minutes TENS and TOT simultaneously per time for 20 times(3 times per week for 7 weeks). In the Bi-group, TENS stimulated the radial and median nerves of the bilateral upper limbs. In the Uni-group, TENS and placebo-TENS stimulated the affected and unaffected side, respectively. In the placebo group, placebo-TENS were placed on bilateral sides. In the control group, subjects did not receive any active treatment. Level of motor impairment was assessed by the Fugl-Meyer Assessment of Upper Extremity (FMA-UE). Result: The Bi-group had a significant greater improvement in FMA-UE than the Uni-group(mean change=2.02, p=0.005), placebo group (mean change=2.49, p=0.001) and control group(mean change=3.08, p<0.001) at post-intervention. The Bi-group(mean change=3.25, p<0.001) and Uni-group(mean change=1.23, p=0.015) showed a significant within-group improvement in FMA-UE since 10 sessions of treatment. No significant change was found in the placebo and control groups. Conclusion: Bi-TENS is superior to Uni-TENS, placebo-TENS and no active treatment in augmenting the recovery of upper limb motor impairment in people with chronic stroke. Author Disclosures: The authors received research support from the Health and Medical Research Fund12131821 from the Food and Health Bureau, HKSAR.

To analyze the effectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users during functional activities. Forty-two wheelchair users, 35 males and seven females: average age of 35 years and an average duration of wheelchair use of 14 years. Subjects were randomly assigned to treatment (n=21) and control (n=21) groups. The treatment group received instruction in five shoulder exercises which they performed daily for 6 months. The exercise protocol included two exercises for stretching anterior shoulder musculature and three exercises for strengthening posterior shoulder musculature. All subjects completed a self-report questionnaire and the Wheelchair Users Shoulder Pain Index (WUSPI) initially and at bimonthly intervals during the 6-month intervention. Seventy-five per cent of the subjects reported a history of shoulder pain since beginning wheelchair use. The average initial performance-corrected (PC-WUSPI) score of the 42 subjects was 17.7 (+/-21.3) with a range of 0-103.2 points. Over 83% of the subjects (35 of 42) completed the 6-month study. Subjects in the treatment group decreased their PC-WUSPI score by an average of 39.9%, compared to decreases of only 2.5% in the control group. These findings supported the effectiveness of this exercise protocol in decreasing the intensity of shoulder pain which interferes with functional activity in wheelchair users.

To evaluate the effect of progressive resistance training of the ankle plantarflexors on gait efficiency, activity, and participation in adolescents with cerebral palsy (CP). Sixty-four adolescents (10-19y; 27 females, 37 males; Gross Motor Function Classification System [GMFCS] levels I-III) were randomized to 30 sessions of resistance training (10 supervised and 20 unsupervised home sessions) over 10 weeks or usual care. The primary outcome was gait efficiency indicated by net nondimensional oxygen cost (NNcost). Secondary outcomes included physical activity, gross motor function, participation, muscle strength, muscle and tendon size, and muscle and tendon stiffness. Analysis was intention-to-treat. Median attendance at the 10 supervised sessions was 80% (range 40-100%). There was no between-group difference in NNcost at 10 (mean difference: 0.02, 95% confidence interval [CI] -0.07 to 0.11, p=0.696) or 22 weeks (mean difference: -0.08, 95% CI -0.18 to 0.03, p=0.158). There was also no evidence of between-group differences in secondary outcomes at 10 or 22 weeks. There were 123 adverse events reported by 27 participants in the resistance training group. We found that 10 supervised sessions and 20 home sessions of progressive resistance training of the ankle plantarflexors did not improve gait efficiency, muscle strength, activity, participation, or any biomechanical outcome among adolescents with CP. Thirty sessions of progressive resistance training of the ankle plantarflexors over 10 weeks did not improve gait efficiency among ambulatory adolescents with cerebral palsy. Resistance training did not improve muscle strength, activity, or participation. Ninety percent of participants experienced an adverse event. Most adverse events were expected and no serious adverse events were reported.

As a result of the improved medical treatment of infectious diseases, these formerly leading causes of mortality in the United States have been supplanted in rank by chronic events as the major causes of death. The major causes include coronary artery disease, respiratory disease, and cancer. Static and dynamic pulmonary functions in the apparently healthy wheelchair user population were measured and then modelled using stepwise regression. One hundred and nine wheelchair users (97 males, 12 females) with paraplegia (n = 77) or quadriplegia (n = 32) gave informed consent and participated in this study. Subjects ranged from being Olympic caliber wheelchair marathon racers to those who live sedentary life styles. Subjects performed three slow vital capacity (SVC) tests, three forced vital capacity (FVC) tests, and three maximal voluntary ventilation (MVV) tests while seated in their standard wheelchair. The order of the pulmonary function tests was randomized. Subjects also completed two functional residual capacity (FRC) measurements. Analysis of variance revealed significant differences in several pulmonary functions based on gender (FEVC, p = 0.0001, FEV1, p = 0.0001, FEVC 25-75%, p = 0.005, PEF, p = 0.002, FIVC, p = 0.002, RV, p = 0.0001, MVV, p = 0.0001, SVC, p = 0.001). The women's unforced prediction equations using age, height, weight did yield some significant correlations with predictions based upon ambulatory subjects. The men's unforced adapted prediction equations did reveal significant correlations with the validation group for FEVC (r = 0.66, p = 0.007), FEV1 (r = 0.62, p = 0.015), PIF (r = 0.95, p = 0.015), MVV (r = 0.57, p = 0.067), SVC (r = 0.69, p = 0.019), and RV (r = 0.67, p = 0.009). Pulmonary function in male wheelchair users should be predicted using equations which incorporate years with disability and level of impairment. Additional study is required to make any recommendations regarding women wheelchair users. However, study of pulmonary function in women should be made a priority. Pulmonary function is affected by the extent of physical impairment, and tends to decline as years with disability increase.

In China, with the acceleration of urbanization, people pay more attention to the quality of urban environment. Air pollution, vegetation destruction, water waste and pollution, and waste sorting have restricted the sustainable development of urban environment. It is important to evaluate the impact of these environmental concerns as a prerequisite to implement an effective urban environmental sustainability policy. The aim of this paper is to establish a system for evaluating sustainable urban environmental quality in China. We extracted six dimensions and 29 criteria for assessing urban sustainable environment. Then, a fuzzy technique and the best worst method were applied to obtain the weights for the dimensions and criteria. Next, grey possibility values were applied to evaluate the sustainable environmental quality of five cities: Beijing, Shanghai, Shenzhen, Guangzhou, and Hangzhou in China. A sensitivity analysis was performed to identify how the ranking of these five cities changed when varying the weights of each criterion. The results show that pollution control, the natural environment, and water management are the three most important dimensions for urban environmental quality evaluation. We suggest that controlling pollutant emissions, strengthening food waste management, improving clean production processes, and utilizing heat energy are the effective measures to improve the urban environment and achieve sustainable urban environmental development.

People with disabilities have the same basic right of access as any other citizen. An inclusive and accessible physical environment is a critical element in mainstreaming disabled people, particularly in developing countries such as India. A freely accessible environment without any physical barrier is the most important requirement of an inclusive society as it determines what differently abled people can be and do. With the increased emphasis on the rights of differently abled people in recent years, it is important to understand the barriers faced by them when accessing the public spaces and facilities. This paper uses focus group discussions and interviews to try to determine the disabling factors in the urban environment that prevent disabled people from participating and explores the role of urban planning in making an accessible and inclusive city. For this the Smart city mission Trivandrum was taken as a platform, as improving the quality of citizens' life is a major goal of India’s smart cities development.

Today, urban development faces complex global challenges that require new approaches to influence its practices and policies. By prioritizing sustainability, mobility, and community resilience, we are moving towards a holistic approach that protects the well-being of residents and the environment. In this dynamic urban design environment, finding ways to identify pedestrian-friendly spaces and create safe, efficient, and sustainable urban environments is a major challenge, and it requires research that seeks to optimize this choice, especially in terms of integrating numerical modeling methods and a wide range of measurement tasks. This research is concerned with optimizing pedestrian accessibility, which directly contributes to reducing environmental impact, improving non-motorized transport, and reducing traffic congestion. It integrates a novel, mixed multi-criteria decision-making (MCDM) model that benefits from the use of Grey’s theory. This research’s purpose goes beyond addressing cities’ immediate challenges; it seeks to contribute to a broader understanding of sustainable urban planning. This study represents a pioneering effort to identify the challenges of optimal site selection for pedestrian walkways. By using a multi-criteria decision-making approach based on mathematical modelling and facility engineering, this effort addresses gaps in the current understanding of site selection criteria and aims to lead a paradigm shift toward a sustainable, efficient, and inclusive urban environment. The results show that the updated RANCOM-PIV greyscale is quite robust and reliable, when comparing the final results of the PIV greyscale and the MARCOS greyscale.

Low mechanical loading of the bones of wheelchair users leads to low bone mineral density (BMD) and increased risk of bone fractures and associated complications. High-load resistance training of the upper body is one way to achieve mechanical loading of the lumbar spine and the hip bones. In addition, maintaining good nutritional status with key nutrients for bone remodeling, that is, vitamin D and calcium, is important for bone accrual. This study aims to investigate the effect of 24 weeks of high-load resistance training combined with nutritional optimization on lumbar spine BMD. Secondary objectives are to investigate the effects of the intervention on (1) bone and physical health parameters, such as bone turnover blood markers, nutritional status, body composition, and maximal muscular strength, as well as (2) exercise motivation and mental health. In this randomized controlled trial, we aimed to include 60 wheelchair users with nonprogressive impairments. Participants were randomly allocated to 24 weeks of either (1) high-load resistance training and nutrition optimization or (2) nutrition optimization only, stratified by sex and sport activity status. The training program consisted of 3 weekly sessions comprising 6 exercises periodized in low-, moderate-, and high-load phases. The nutritional optimization aimed to ensure sufficient intake of protein, vitamin D, and calcium. BMD and body composition; maximal muscular strength; and nutritional, physical, and mental health status were assessed at baseline, midpoint, and postintervention visits. Furthermore, follow-up assessments of a subgroup were conducted at 6 to 18 months after the intervention. This protocol was approved by the Regional Committee for Medical and Health Research Ethics South-East, Norway. Recruitment occurred between November 2022 and 2023. A total of 68 wheelchair users were screened for eligibility, of whom 45 (66%) were enrolled and allocated to one of the study groups (n=24, 53% training group; n=21, 47% control group). At the midpoint and postintervention visits, 36 (n=17, 47% and n=19, 53%, respectively) and 33 (n=14, 42% and n=19, 58%, respectively) participants were assessed, respectively. Analysis of the data collected at the screening visit commenced in spring 2024, while analyses of data collected at the baseline and retest visits began in autumn 2024. Publication of the results of this study is expected by the end of 2025. This protocol presents the first randomized controlled trial of a high-load resistance training intervention in wheelchair users, focusing on bone, physical, and mental health. The results will contribute to new knowledge in exercise science for this population and generate novel hypotheses for future studies.

Mild cognitive impairment (MCI) may be a precursor to dementia; however, its progression may be prevented or slowed with exercise. This study aimed at determining the effects of group aerobic and strength training on cognition, conditioning, muscle endurance, and balance in underprivileged community-dwelling older adults with MCI. This was a single-blind, randomized, and matched-pair controlled (gender, age, body mass index, and Addenbrooke's Cognitive Examination-Revised for MCI diagnosis) clinical trial. It was developed in 4 community centers. Fifty-two sedentary, functionally independent individuals, aged 60 years or more, with MCI were randomized into intervention group (n = 26) and control group (n = 26). Participants were tested before and after a 24-week exercise program. Sociodemographic characteristics, cognition (Mini-Mental State Examination), conditioning (2-minute stationary walk test), lower-limb endurance (30-second sit/stand test), and balance data (Functional Reach test) were collected. The intervention group walked and exercised twice weekly (60 minutes each) using ankle weights, latex resistance bands, and dumbbells. The exercise load and intensity were regularly increased on the basis of a preestablished incremental number of sets and repetitions and on the basis of the participants' correct movement execution with a given load. Data were analyzed with Pearson χ test, Fisher exact test, Student t test, Mann-Whitney U test, 2-way repeated measures analysis of variance, and the Cohen d. Before the intervention, no significant differences were found between groups for any of the variables. Postintervention, significant differences were observed in cognition, conditioning, muscle endurance, and balance. Significant time-by-group interactions were detected in all the intergroup analyses. The improvements observed in the intervention group had medium to large effect sizes (0.35-1.15). The control group's decrease in cognition (13.9%) had a large effect size, while its Functional Reach test decrease (11.4%) had a medium effect size, with no significant change in conditioning or muscle endurance. The training program improved cognitive function, muscle endurance, aerobic conditioning, and balance in older adults with MCI.

The horrors of Taiwan’s 921 Earthquake and 88 Flood undoubtedly demonstrated the power of nature, allowing us to observe the tensions between the natural environment and civilization and to understand the various imbalances in the interactive relationship between the sky, the land, and the human race encountered during urban developments. Today, the “city” has adoptedthe important role of an arena that corresponds to the governance of the environment. This contains two meanings. One is as a source of strength for the increasing collective consciousness of society; the other is as a practice field for changing the spatial environment. Previously, urban planning was established based on the “economy,”adopted actions from “space,” and determined the problems of the “environment” and “society.” However, we are currently facing a counterattack from the forces of nature, which include climate change. Thus, we must even more urgently consider the relationship between humanity and nature. Therefore, sustainable development in city planning must adjust the relationshipsamong the natural ecology, economic development, and humanistic society to facilitate a rich and diverse ecological environment, a flourishing economic environment, and a safe and peaceful life environment.Thus, an urban environment that is suitable for inhabitance can be created. This study employs three cases as subjects, using “green” and “places” as the main axes of the design mode of operation, creating feasible strategies for the ecology of “green” and “places,” and facilitating low-carbon and creative urban developments. This study realizes sustainable building concepts and practices at different levels in anticipation that the regional physical environment can satisfy users’ demands and create a safe, healthy life environment, providing another feasible reference for building strategies in the “green” and “places” of Taiwan’s urban and rural landscape. The primary research method used in this study is a review of relevant literature on sustainable urban development. This literature review is also performed to understand the concepts, meanings, and principles of “sustainability” and “sustainable cities” and the models and characteristics of sustainable urban development to provide a theoretical foundation for sustainability strategies. In addition, we analyze the conditions and structures of sustainable urban development and the bases of sustainable development models for urban space. Sustainable environmental construction, the reuse of cultural assets, and the application of green technology are applied as operating directions. Case operations of design in actual regions are used to provide rural and urban planning concepts, development principles, and building strategies under the concepts of sustainable development.

Urban green spaces play a crucial role in enhancing the quality of life in cities, offering a myriad of environmental, psychological, and economic benefits. This article explores the integral role of these spaces in urban environments, highlighting their importance in promoting biodiversity, reducing urban heat, improving air quality, and enhancing community well-being. Through a detailed examination of various global case studies, the review underscores the successful integration of green spaces into urban planning and the substantial positive impacts on city residents and ecosystems. The challenges of land use conflicts, maintenance, sustainability, and accessibility are addressed, offering a comprehensive overview of both the hurdles and opportunities in optimizing urban green spaces. The review advocates for robust strategies to overcome these challenges, emphasizing the need for increased community involvement, innovative use of technology, and strategic policy implementation to foster sustainable and inclusive urban green environments.

This thesis attempts to determine through the analyses of Australia’s current suburban demographics and user groups, ‘perceived’ utilisation trends, how future architectural propositions for built forms can at minimum, accommodate the surrounding suburban needs and at best, enhance individual’s experiences of an urban environment in which the inhabitable spaces are as desirable and inclusive as an individuals place of home and work. It achieves this by gathering together and analysing the works of a small, but knowledgeable group of authors, to allow an informative discussion of theories (whether they are right or wrong) that contribute towards formulating a perspective on the possible solutions, and their adaptation within the context of the Australian urban environment. Chapter 1 discusses three theories of Urban Development, with a generalised explanation of each authors’ (Hugh Barton and colleagues, David Engwicht and Peter Katz) themes and development principles. The chapter also embodies an analytical discovery of urban infrastructure requirements and lists five user groups that represent a spectrum of minority users. Chapter 2 provides a broad insight into Australia’s demographics and the conditions that constitute the lifestyle of the majority of Australia’s current metropolitan populations, through an in-depth focus on the city of Brisbane and three suburbs, using 2001 census data and a suburban mapping exercise. Chapter 3 utilises the development themes discussed in chapter 1, to establish the base line of the present situation, for a case study. This study uses three analyses to produce a future urban development framework, resulting in design considerations that enable community interaction within an urban condition, which reflects the existing context of the suburb.

A growing number of urban development and public health professionals are developing expertise in how urban environments influence population health to support preventive health (PH) planning, implementation and outcomes. This study aimed to address the growing interest among these experts in Sydney, Australia, to move beyond silo-based approaches to PH planning and urban development by developing a preliminary mapping of the complex adaptive system. This is a network of agents and parts that collectively relate and interact, where they seek to intervene by meshing the disparate knowledge of their multidisciplinary expertise. This mapping will help experts to better integrate PH approaches by linking primordial and primary prevention within urban environments, collectively prioritising areas for intervention within the complex adaptive system, and developing a better understanding of relations between multiple factors at play within it. The system map was developed using a unique participatory system-mapping (PSM) process involving a modified Delphi technique consisting of three rounds between October 2019 and August 2020 and 15 urban development and public health experts engaged in PH in Sydney's urban environment. The final system map encompassed features of the local environment, determinants of health and wellbeing in urban environments, pre-clinical health and wellbeing impacts, and clinical health outcomes, providing a comprehensive map of the adverse effects of urban environments on population health. There was a high level of agreement among experts on the final system map. While experts from different disciplines generally agreed on priority areas for intervention, consensus was higher among those from similar disciplinary backgrounds. The study highlights how the collective intelligence of experts from diverse disciplines can generate PSM. Furthermore, it illustrates how using systems mapping can help experts interested in complex public health problems to take a broader view of the complex adaptive system for PH planning, support collaborative prioritisation, and offer valuable insights for targeted interventions.