PLOS ONE
RESEARCH ARTICLE
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OPEN ACCESS
Citation: Zhu Y, Li H, Lyu S, Shan X, Jan Y-K, Ma F
(2023) Stair-climbing wheelchair proven to
maintain user’s body stability based on AnyBody
musculoskeletal model and finite element analysis.
PLoS ONE 18(1): e0279478. https://doi.org/
10.1371/journal.pone.0279478
Editor: Gustavo Plaza-Manzano, Complutense
University of Madrid: Universidad Complutense de
Madrid, SPAIN
Received: October 27, 2022
Accepted: December 7, 2022
Published: January 26, 2023
Copyright: © 2023 Zhu et al. This is an open access
article distributed under the terms of the Creative
Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in
any medium, provided the original author and
source are credited.
Data Availability Statement: All datasets are
publicly available at: https://doi.org/10.6084/m9.
figshare.21701456.v2.
Funding: This research was supported by the
National Key R&D Program of China
(2020YFC2005801) to Xinying Shan. Authorized
Unit: National Research Center for Rehabilitation
Technical Aids. URLs to sponsors’ websites:
https://chinainnovationfunding.eu/national-key-rd-
programmes/. The funders had no role in study
PLOS ONE | https://doi.org/10.1371/journal.pone.0279478 January 26, 2023
Stair-climbing wheelchair proven to maintain
user’s body stability based on AnyBody
musculoskeletal model and finite element
analysis
Yancong Zhu1☯, Haojie Li ID2☯, Shaojun Lyu2*, Xinying Shan ID1,3*, Yih-Kuen Jan ID4,
Fengling Ma3
1 School of Biological Science and Medical Engineering, Beihang University, Beijing, China, 2 School of P.E
and Sports, Beijing Normal University, Beijing, China, 3 Department of Rehabilitation Technical Aids for Old-
Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China, 4 University of
Illinois at Urbana-Champaign Champaign, Champaign, IL, United States of America
☯ These authors contributed equally to this work.
* l13121860699@163.com (SL); shanxinying@nrcrta.cn (XS)
Abstract
The electric stair-climbing wheelchair is a beneficial mobile assistance device for older
adults and disabled persons with poor walking ability, as it reduces the daily walking and
climbing burden. In this paper, 11 older adults were tested when using a stair-climbing
wheelchair in three environments: flat ground, slopes, and stairs. The kinematic and
dynamic parameters of the lower limb joints were simulated by AnyBody 7.2 human model
simulation software using Vicon 3D infrared motion capture, a 3D force table, and analyzed
by ANSYS 19.2 Workbench. The joint force, joint moment, and muscle strength did not
change significantly under the three environments when using the wheelchair. Through
finite element analysis of the mechanical properties of the human body, when using the
wheelchair, no significant differences in the overall stress distributions of the fifth lumbar
spine, hip bone, or femur were found among the three environments, no significant differ-
ences in deformation and displacement were found, and the stress distribution was rela-
tively stable. Therefore, the human body is stable enough to use the electric stair-climbing
wheelchair in the three test environments, all of which will be commonly encountered in
daily life.
1. Introduction
The aging of the population is a global trend, and it is becoming a global challenge. In 2019,
the 26th World Population Prospects Report of the United Nations noted that the world popu-
lation is aging continuously. Older adults aged 65 and above accounted for one-tenth of the
total population in 2019, and as the fastest-growing age group, are expected to account for
one-sixth of the total population in 2050 [1]. According to the seventh census of China
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design, data collection and analysis, decision to
publish, or preparation of the manuscript.
Competing interests: NO authors have competing
interests.
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Stair-climbing wheelchair proven to maintain user’s body stability
conducted in 2020, China’s population has exceeded 1.4 billion people, of which 264 million
are over 60 years old, accounting for 18.7% of the total population; this is an increase of 5.44
percentage points compared with 2010. Some studies predict that the trend of population
aging will continue in the next 10 years and peak in 2059, when there will be one older adult
out of every three people [2]. Unfortunately, aging is accompanied by increased risk for many
diseases and disabilities. Owing to a decline in physiological function or the influence of car-
diovascular and cerebrovascular diseases, many older adults have difficulties standing and
walking and face various challenges in their daily lives. For older adults, stair climbing is one
of the most challenging and dangerous activities of daily life [3]. Jensen [4] noted that stair
climbing is faced daily and is a critical aspect of community life. Many older adults and people
with certain disabilities need to use crutches or wheelchairs for assistance with walking and
climbing stairs.
Wheelchairs are an essential mobility device for many older adults and physically disabled
people. Electric wheelchairs have been widely used for many years. Today, it is quite common
for an electric wheelchair to be a person’s primary mobility device to aid in daily activities,
both indoors and outdoors [5]. However, it is still challenging for a standard electric wheel-
chair to overcome environmental barriers, such as stairs in buildings or civil infrastructure [6],
especially for people living in buildings without elevators. Studies have shown that going uphill
and climbing stairs are critical obstacles for wheelchair users, and it is difficult for older wheel-
chair users to overcome steps with a height of more than 20 cm [7]. Most electric wheelchairs
require external assistance when traveling uphill and climbing stairs, so older adults may face
risks when attempting to travel uphill independently. In addition, elevators cannot be used
during disaster evacuations, such as for fires, earthquakes, and other disasters. Therefore, for
the safety of wheelchair users, the ability to travel up and down stairs is a vital issue.
To solve these problems, many designers have designed age-appropriate wheelchairs with
usefulness and safety as the core principles [8]. For example, Erwin Prassler’s WHEELESLEY
wheelchair adopts advanced human–computer interaction and environment perception tech-
nology, and it achieves intelligent obstacle avoidance [9]. Yi et al. successively designed intelli-
gent wheelchairs based on surface electromyography (EMG), lip control, and wrist potential
control [10–12]. However, these studies mainly focused on four aspects: motion control of the
automatic platform, unique assistive technology, environmental awareness and navigation sys-
tems, and human–computer interaction technology [13]. Studies on the stability of stair-
climbing wheelchairs are limited to the mechanical structural design and dynamic analysis of
wheelchairs, and there are few studies on the stability of older wheelchair users, especially their
physical stability, during stair climbing.
The aging process involves physiological and musculoskeletal changes, and the muscle
strength of the lower limbs decreases with age [14, 15]. Wheelchairs tilt to various angles while
climbing up and down slopes and stairs, which may cause body instability and reduce the com-
fort of the wheelchair user. In addition, when wheelchairs move from a flatter surface to a
steeper surface, the impact force caused by the change in the acceleration of the wheelchair
may cause instability in the lower limbs. However, studies in these areas are rare. Therefore,
based on a human body dynamics finite element analysis, we used the biomechanical simula-
tion software AnyBody and ANSYS Workbench to conduct inverse dynamics calculation and
infinite element analysis on the lower limb joint force, joint moment, and muscle strength of
older adults using an electric stair-climbing wheelchair on flat ground, slopes, and stairs. The
dynamic data on the joint force, joint moment, and muscle strength were analyzed using
inverse kinematics (IK), and the data on the ischium and femur were analyzed using finite ele-
ment stress and strain analyses. A comparative analysis helped us find the different bio-
mechanical mechanisms of the body during the different uses of the electric stair-climbing
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Table 1. Anthropometric details of participants (mean ± standard deviation).

Number of participants Sex Age (y) Height (cm) Mass (kg)
11 Female 50.82 ± 7.62 160.36 ± 4.67 63.27 ± 6.04
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wheelchair. This study can provide a theoretical basis for verifying the efficacy and evaluating
the ride comfort of electric stair-climbing wheelchairs.

2. Materials and methods

2.1 Ethics statement
All methods in this study were performed in accordance with the Declaration of Helsinki rele-
vant guidelines and regulations. This study was reviewed and approved by the Ethics Commit-
tee of the China National Rehabilitation Center (No. S20220206). The participants provided
written informed consent to participate in this study. The potential risks and benefits of partic-
ipation in this study were explained to each participant in advance. All participants provided
signed informed consent before participation.

2.2 Participants
Eleven individuals (11 females) from the National Research Center for Rehabilitation Techni-
cal Aids of China participated in the study. Participants were recruited based on their age and
physical condition. They were in good physical condition and had had no injuries to their
lower extremities, ankle, knee, or hip joint within the past six months. Their dominant leg was
on the right side. After confirming study eligibility, participants provided informed written
consent for the study protocol as approved by the Office of Research Ethics at the National
Research Center for Rehabilitation Technical Aids of China. The basic information of the par-
ticipants is shown in Table 1.

2.3 Instrumentation
In this study, the electric stair-climbing wheelchair was a wheel-track composite wheelchair, as
shown in Fig 1A. This wheelchair fully combines the advantages of a wheel mechanism and
track mechanism and can run like an ordinary electric wheelchair when on flat ground. When
encountering stairs or obstacles, the track can be lowered to become a climbing mechanism.
This device is the stair-climbing wheelchair. The mechanical system of the wheelchair is
mainly divided into a crawler drive module, balance car module, automatic support mecha-
nism of the crawler drive module, auxiliary wheel and its automatic support mechanism,
design and layout of the sensor system, and whole-frame structure. The specifications of the
stair-climbing wheelchair in this experiment were as follows: dimensions of 876 mm × 750
mm × 650 mm, maximum speed on the ground of 1.5 m/s, maximum speed on stairs of 0.3 m/
s, climbing capacity of 33.6˚, stair width of �300 mm, and stair height of �200 mm.
The staircase used in the experiment is shown in Fig 1B, with a width of 260 mm, a height
of 170 mm, and a slope of 33.18˚, which conforms to the stair slope and step specifications in
the Chinese civil building design code [16].
We selected twelve Vicon T20S cameras as data acquisition equipment for kinematic shoot-
ing. To ensure the accuracy of data acquisition, six cameras were mounted, and six cameras
were scaffolded, as shown in Fig 1C. The specifications of the cameras were as follows: pro-
duced by OML, UK; resolution of 2352 × 1728 pixels, 4 million pixels, and acquisition fre-
quency of 100 Hz. Two 3D force-measuring tables (928E, Kistler, Switzerland) were used to

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Fig 1. (A) Electric stair-climbing wheelchair used in the test. (B) Simulated slope and stairs. (C) Field test
environment diagram. (D) VICON infrared motion-capture equipment and surface EMG equipment.
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collect the surface reaction force data with a sampling frequency of 1000 Hz and a static detec-
tion error of less than 0.5%. The experimental equipment are shown in Fig 1D.

2.4 Testing protocol

First, we adjusted the VICON camera positions. The mounted and scaffolded cameras formed
a semiarc around the center of the test area (Fig 1C). The distance between each camera and
the simulated stairs was 2 m. Before the experiment, we debugged the system to check whether
the equipment could run normally and ensure that each camera could capture a picture simu-
lating the staircase. Calibration included calibration of the global coordinate system in space
and calibration of the position of the force platform.
The study participants wore uniform black elastic short sleeves, shorts, and black socks to
reduce the introduction of error by other variables, and 25 reflective marker dots were attached
to the participants according to the location of the marker dots on a bone–muscle model. The
positions of the marker points included the left and right anterior head, left and right posterior
head, sternum, clavicle joint, 10th thoracic vertebra, sternal xiphoid process, left and right
anterior superior iliac spine, left and right posterior superior iliac spine, left and right lateral
lower one-third of the thigh, left and right external epicondyle of the fibula, right lateral lower
one-third of the calf, left lateral lower half of the leg, left and right heel, left and right lateral
malleolus, left and right first metatarsal, and left and right fifth metatarsal [17, 18].
As shown in Fig 2, the participants traversed the ground, slope, and stairs by using the
wheelchair, and the Vicon cameras captured their motion.

2.5 Data processing and analysis

In this study, data were collected by a BTS 3D infrared-based motion capture system and Kis-
tler 3D force plate. Data calculation was conducted by AnyBody 7.2 musculoskeletal modeling.
Infinite element analysis was performed using ANSYS 19.2 Workbench (Cybernet Systems
Co., Ltd., Tokyo, Japan).

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PLOS ONE Stair-climbing wheelchair proven to maintain user’s body stability

Fig 2. Test scheme. T1: flat ground environment, T2: slope environment, T3: stair environment.
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The biomechanical simulation software AnyBody 7.2 was used for the 3D motion-capture
dynamics analysis. The muscle forces were solved by inverse dynamics simulation, which cal-
culates and specifies the mode of muscle activity through which the desired motion is accom-
plished [19, 20].
2.5.1 Skeletal muscle model of the lower limbs. A new lower limb model was built based
on the lower limb model in AnyBody by Vicon Nexus 2.6.1. Data were collected from the
lower limb movement model. We used 12 Vicon T20S cameras to model the movement data
of reflex markers on the participants and exported the 3D files. Then, we imported the 3D files
into AnyBody 7.2 to build skeletal muscle simulation models of the subjects using wheelchairs
in the three test environments (Fig 3).
The skeletal muscle model constructed in AnyBody is a standard multibody dynamic
model consisting of a rigid body, kinetic pairs, kinematic actuators, and force/moment actua-
tors, such as muscles. The force or moment obtained is solved mainly through multibody
dynamics simulation [21].

Fig 3. Musculoskeletal models of a subject using the wheelchair in the three test environments.
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PLOS ONE Stair-climbing wheelchair proven to maintain user’s body stability

The muscular system usually contains more muscles than are needed to drive the joints.
This problem is usually solved by the central nervous system (CNS), which controls the activa-
tion/recruitment of muscles. The AnyBody modeling simulation system provides a standard
mechanism for selecting optimal muscle systems to simulate how the CNS works:
Minimize Gðf ðMÞ Þ; ð1Þ

Cf ¼ d; ð2Þ

0 � fiðMÞ � Ni ; i 2 f1; . . . ; nðMÞ g; ð3Þ

where G is an objective function of the distribution strategy of the assumed CNS to the muscle
stress; fiðMÞ is the muscle force of the external equilibrium load, and it is the dependent variable;
Cf = d is the dynamic balance equation solved by the human muscle model; C is the matrix of
the equation system; d is the sum of inertia force and external force; and Ni is the strength of
the muscle to be calculated.
The calculation formula of muscle recruitment is as follows:
!p
ðMÞ
� XnðMÞ fiðMÞ
G f ¼ ; ð4Þ
i¼1 Ni

where p is a polynomial power series (p � 1). When p is set to different values when the power
series is large, the number of muscles balancing the external force will be higher, and the syn-
ergy effect will be significant [22]. When the muscle model or human physiological system is
in such a balanced state, due to the collective protection mechanism, the maximum relative
load on muscles is required to be minimal. At this point, the muscle activity is minimal to
avoid muscle strain caused by excessive stress:
!
fiðMÞ
max ; i ¼ 1; 2; 3; . . . ; nðMÞ : ð5Þ
Ni

The calculated dynamic indices were imported into Excel for standardized processing: in
the first treatment, joint force and joint moment were divided by body weight (unit: N/BW)
[23]; in the second treatment, the muscle strength of the lower limbs was divided by body
weight and multiplied by 100% (N/BW) [24].
2.5.2 Bone finite element analysis. We established a finite element model of bones based
on CT scans of the lumbar spine, hip, and femur of a healthy middle-aged woman (56 years
old, 162 cm, 65 kg). The model included the fifth lumbar vertebra, the left and right hipbones,
and the femur of the right leg. We imported the original DICOM image of bone CT data into
Mimics 20.0 (Materialise, Leuven, Belgium), extracted the bone, and exported the STL format
by dividing the finite bone element into tetrahedrons. The bone and the retrograde mesh were
restored by Geomagic Wrap 2013 (Geomagic Company, Research Triangle Park, NC, USA),
which was used to fill the holes and repair sharp corners, and the IGES format was exported
after the treatment was completed. Finally, the Young’s modulus and Poisson’s ratio of the
fifth lumbar vertebra, hip bone, and femur were added to ANSYS 19.2 Workbench to perform
constraint fixation on the three bones. Toyohara’s study demonstrates that Young’s modulus
is 11,000 MPa and Poisson’s ratio is 0.2 [25]. Moreover, all tissues were defined as uniform iso-
tropic material for simplification and their material properties were taken from the experimen-
tal results by Wirtz et al. [26]. Gridding method: we created grid skeletons and joints with
tetrahedral elements, each of which was composed of 10 nodes. The average quality of

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elements was 0.75, indicating that the grid was of good quality. As a comprehensive index for
quality, element average quality ranges from 0 to 1, with values of 0 and 1 respectively repre-
senting an element with zero volume and a perfect cube.
Load and boundary conditions: We conducted this experiment in a static simulation envi-
ronment. To correctly simulate the conditions where participants walk and sit in a wheelchair,
loads on finite element models were calculated by AnyBody’s inverse dynamics. Loading force
refers to joint force at the joint connection, whereas loading facet refers to the articular facet at
the joint connection specified by AnyFE2Abq plug-in of AnyBody.
Variables measured: this study focused on the structural displacement and von Mises stress
of three bones. The former is composed of a three-dimensional displacement value and direc-
tion, and the latter is a scalar value from normal stress and shear stress with no distinction
between tension and compression.
The net joint force was loaded to the upper articular surface of the lumbar spine, the lumbo-
sacral articular surface of the hip bone, and the femur trochanter, and then the force and defor-
mation displacement of the bone were analyzed.

2.6 Statistics
All analyses were performed with statistical analysis software SPSS (SPSS Version 26.0, SPSS
Inc., Chicago, IL, USA). The results are expressed as the mean and standard deviation
(mean ± SD). T-test and analysis of variance were used to compare the dynamic data of the
three movements in different environments. Differences were statistically significant if
P < 0.05.

3. Results
3.1 Dynamic comparisons of three lower extremity joints in three
environments
3.1.1 Stress comparisons on three joints of the lower limbs in three environments. As
shown in Table 2, the X, Y, and Z forces of the hip, knee, and ankle joints were measured when
using wheelchair. there were no significant changes in the joint load on the hip, knee, or ankle
joints in slope and stair environments compared to flat ground environments.
3.1.2 Comparison of joint moment of the lower limbs in three environments. As
shown in Table 3, the joint moments of the wheelchair groups were compared and analyzed in
the three environments: flat ground, slope, and stairs. When using a wheelchair, no significant

Table 2. Mean and standard deviation (mean ± SD) of the maximum joint force of the hip, knee, and ankle in three environments. Units: N/BW.
Joint force Direction Flat ground Slope p-value stairs p-value
Hip joint X-axis −0.03 ± 0.02 −0.07 ± 0.01 0.274 −0.24 ± 0.11 0.063
Y-axis 9.27 ± 1.77 9.29 ± 1.50 0.726 9.09 ± 1.75 0.489
Z-axis 2.40 ± 0.37 2.23 ± 0.41 0.631 2.10 ± 0.46 0.564
Knee joint X-axis 0.22 ± 0.07 0.09 ± 0.08 0.161 0.05 ± 0.06 0.063
Y-axis 0.29 ± 0.13 0.40 ± 0.22 0.554 0.36 ± 0.06 0.700
Z-axis −0.83 ± 0.40 −0.85 ± 0.48 0.928 −0.79 ± 0.36 0.846
Ankle joint X-axis 0.04 ± 0.02 0.23 ± 0.18 0.251 −0.10 ± 0.20 0.076
Y-axis 0.33 ± 0.28 0.57 ± 0.57 0.372 0.47 ± 0.31 0.091
Z-axis −0.27 ± 0.04 −0.42 ± 0.39 0.561 −0.40 ± 0.31 0.657

Note: X-axis is the sagittal axis, Y-axis is the vertical axis, and Z-axis is the frontal axis.

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Table 3. Mean and standard deviation (mean ± SD) of the maximum joint moment of the hip, knee, and ankle in three environments. Units: Nm/BW.
Joint moment Group Flat ground Slope p-value Stairs p-value
Hip abd/add Wheelchair 0.09 ± 0.04 0.08 ± 0.06 0.728 0.09 ± 0.04 0.860
Hip flex/ext Wheelchair 0.18 ± 0.13 0.25 ± 0.07 0.534 0.29 ± 0.06 0.606
Knee flex/ext Wheelchair 0.03 ± 0.01 0.05 ± 0.03 0.231 0.04 ± 0.03 0.361
Ankle flex/ext Wheelchair 0.06 ± 0.03 0.03 ± 0.02 0.085 0.03 ± 0.01 0.054
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differences were observed in hip abduction/adduction (abd/add), hip flex/ext, knee flex/ext, or
ankle flex/ext moments in slope and stair environments compared to flat ground
environments.

3.2 Comparison of lower limb muscle strength in three environments

As shown in Table 4 and Fig 5, we compared the lower limb muscle strength of the wheelchair
group in three different environments. As for the wheelchair group, there were no significant
differences in muscle strength in slope and stair environments compared to flat ground
environments.

3.3 Finite element analysis of skeletons in three environments while using

wheelchairs
In the established finite element model, the maximum joint force of the participant during the
entire movement process is taken as the load for static simulation calculation. The shear force
from AnyBody’s inverse dynamics calculation decides the load direction. Load facets refer to
the articular facets in contact between joints during human activities.
3.3.1 Finite element stress analysis of the skeleton. We conducted finite element analysis
on the participants using the wheelchair in the three environments, and the results are shown
in Fig 4. Fig 5 presents the minimum-maximum distribution of skeletal stress. The maximum
stress of the hip bone was located at the ischial tuberculum under all three environments. The
stress in the slope environment was slightly higher than that in the flat ground environment,
and the stress in the stairs environment was slightly lower. The stress position of the fifth lum-
bar vertebra was at the end of the facet of the lumbar joint, the average stress values of the

Table 4. Mean and standard deviation (mean ± SD) of the maximum of lower limb muscle strength in three environments. Units: N/BW.
Muscle Flat ground Slope p-value Stair p-value
Adductor longus 34.95 ± 29.72 34.50 ± 7.57 0.640 28.19 ± 10.00 0.447
Sartorius 73.22 ± 33.15 74.67 ± 39.42 0.759 64.49 ± 26.31 0.640
Gluteus maximus 2.56 ± 0.14 2.89 ± 0.89 0.773 3.56 ± 1.21 0.477
Gluteus minimus 15.08 ± 5.79 17.97 ± 8.80 0.313 19.65 ± 7.75 0.279
Popliteal muscle 0.19 ± 0.34 0.10 ± 0.19 0.164 0.18 ± 0.44 0.329
Soleus 0.09 ± 0.12 0.39 ± 0.01 0.062 0.16 ± 0.04 0.103
Rectus femoris 70.64 ± 22.5 80.57 ± 21.16 0.298 81.54 ± 22.26 0.159
Biceps femoris 14.11 ± 7.58 11.95 ± 9.24 0.641 11.72 ± 5.72 0.660
Vastus lateralis 11.84 ±2.07 12.80 ± 1.49 0.876 14.46 ± 2.74 0.675
Vastus medialis 1.10 ± 0.90 0.65 ± 0.27 0.338 1.04 ± 0.52 0.829
Tibialis anterior 5.60 ± 5.36 4.38 ± 4.05 0.649 5.01 ± 4.75 0.770
Gastrocnemius 0.42 ± 0.40 0.96 ± 1.20 0.324 1.84 ± 1.10 0.093
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Fig 4. Equivalent stress distribution of the hip bone, lumbar spine, and femur in the stair-climbing wheelchair.
The warmer the color, the greater the stress. The red arrow indicates the maximum stress.
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three environments were 1.14 MPa, 1.18 MPa, and 1.16 MPa, and the distribution of primary
stress did not change. The maximum stress of the femur in the flat ground environment was
located at the back and upper part of the femur body, whereas the maximum stress of the
femur was located at the neck of the femur in both the slope and stairs environments, and the
stress values in these environments were significantly higher than in the flat ground environ-
ment. According to the overall stress change curves in Figs 4 and 5, among the three environ-
ments of flat ground, slope, and stairs, the stress values of the three bones exhibited no
significant changes, and the stress distributions were relatively stable.
3.3.2 Finite element deformation displacement analysis of the skeleton. We compared
the bone stress of the wheelchair group among the three environments. As shown in Figs 6
and 7, the results of the skeletal strain analysis show that when using a stair-climbing wheel-
chair, the hip, fifth lumbar vertebra, and femur displacement were not significantly different in
the different environments.
The maximum displacement and maximum stress of the hip and femur were consistent.
The maximum displacement of the fifth lumbar spine was located at the lower end of the lum-
bar joint. Comparing the displacement of the bones, the displacement of the hip was the larg-
est, followed by the displacement of the lumbar vertebra and the displacement of the femur.
The overall displacement distributions of the three bones were relatively stable.

Fig 5. Change in mean values of maximum equivalent stress of hip, lumbar, and femur stress in three
environments (flat ground in blue; slope in purple; and stairs in pink).
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Fig 6. Resultant displacement distributions of the hip bone, lumbar spine, and femur in the stair-climbing wheelchair. The red
arrow indicates the maximum displacement position.
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4. Discussion
In daily life, the energy consumption of walking is high, and walking can be difficult or danger-
ous for older adults [27]. Wheelchairs are essential mobility devices for many people, and they
can effectively reduce the muscle power required for mobility [28]. Metabolic cost reduction is
optimized through wheelchair-related equipment. In this study, the daily use of a new electric
stair-climbing wheelchair was investigated in detail in terms of its application in three environ-
ments (flat ground, slope, and stairs) encountered in daily life.
In this paper, we found that there were no significant differences in lower limb joint stresses
and muscle strength when using wheelchairs in the three environments. Queen [29]

Fig 7. Changes in mean values of maximum resultant displacement in stair-climbing wheelchair in three
environments (flat ground in blue; slope in purple; and stairs in pink).
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discovered that the muscle strength and stability of the lower limbs decrease significantly with
age, resulting in the increased risk of falling while ascending stairs due to poor muscle stability
and electric stair-climbing wheelchairs can reduce the muscle strength required to climb stairs.
That conclusion was verified in this study. For example, whereas lower limb Joint force, Joint
moment and muscle strength did not change among the three environments when using the
stair-climbing wheelchair. Therefore, the stair-climbing wheelchair studied in this paper is
proven practical in different environments.
In addition, based on the finite element analysis of the stress and strain of a healthy wom-
an’s fifth lumbar vertebra, hip, and femur, we analyzed the bone stress involved in sitting in
the stair-climbing wheelchair in the three environments. The maximum stress of the fifth lum-
bar vertebra was on the upper end of the lumbar articular facet in all three environments. The
maximum displacement was on the lower end, which is the same result as that in the study by
Guo [30], because the waist is in the vertical posture during the normal sitting posture, and the
lumbar posture in the vertical posture will increase the stress in the anterior and lateral discs of
the lumbar vertebra. This study found that the maximum stress reached 7.21 MPa, and the
maximum stress should not be exceeded to maintain the comfort of the sitting position. For
example, Ciaccia & Sznelwar [31] and Conine [32] stated that the skeletal stress threshold,
where the skeleton should not exceed its maximum stress threshold in motion, would other-
wise block the capillaries, depriving tissues of oxygen, and the body would then experience dis-
comfort. In this study, the maximum stresses of the fifth lumbar spine were 2.29 MPa (flat
ground), 2.36 MPa (slope), and 2.32 MPa (stairs), all of which were lower than the maximum
stress of 7.21 MPa, and the distribution of lumbar pressure was consistent with that found by
Berkson [33]. Based on our analysis of the pressure on the hips, we conclude that when partici-
pants used the wheelchair, the most significant stress was concentrated on the ischial tubercle
in all three environments, as the ischium is in the top support position when sitting. Regarding
femoral stress, we found that the maximum stress of the femur was in the upper part of the
femur; in the case of the slope and stairs, the maximum stress was in the femoral neck, and the
stress was mainly produced by the reaction moment and the muscle moment. This is because
the pressure distribution of the wheelchair is mainly on the muscles around the hips and the
hips, and during ascent, the legs are suspended and cannot be appropriately supported, creat-
ing stress in the neck of the femur.
Finally, according to the three skeletal stress and strain displacement diagrams, the stress
distributions of the fifth lumbar vertebra, hip bone, and femur stayed approximately the same
under the different environments. The strain displacement was not significantly changed, and
the strain displacement or stress did not increase with the continuous increase in the steepness
of the slope or stairs, which is a good indication that the stair-climbing wheelchair user’s body
will remain stable while ascending slopes and stairs. This wheelchair can adjust the body pos-
ture according to environmental changes and offers good stability and comfort. In addition,
previous studies have mainly focused on the characteristics of kinematics. This paper verifies
the consistency of the data by combining dynamics and finite element simulation parameters,
allowing people to use climbing wheelchairs for adequate and reasonable scientific
verification.

5. Conclusion
As the most efficient mobility device for older adults and the physically disabled, wheelchairs
can play a vital auxiliary role in daily life. This paper investigates and verifies the dynamics of
the lower extremities while using a stair-climbing wheelchair in three environments encoun-
tered in daily life. Comparative analysis shows that with an independently designed wheelchair

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PLOS ONE Stair-climbing wheelchair proven to maintain user’s body stability

in this experiment, the bodies of the wheelchair users move more smoothly and stably in all
three environments and show no changes among the three environments. However, there is
no further comparative study on different types of stair-climbing wheelchairs. Future work
will verify the physical force and stability of different electric wheelchairs by comparing differ-
ent climbing wheelchairs, guide the improvement of the stability and comfort of wheelchairs,
and propose design suggestions from the perspective of human force.

Acknowledgments
The authors thank sports biomechanics laboratory of the China National Rehabilitation Center
for their support in data collection.

Author Contributions
Conceptualization: Haojie Li.
Data curation: Shaojun Lyu, Fengling Ma.
Funding acquisition: Xinying Shan.
Project administration: Xinying Shan.
Resources: Fengling Ma.
Software: Shaojun Lyu.
Supervision: Yancong Zhu.
Writing – original draft: Yancong Zhu, Haojie Li.
Writing – review & editing: Haojie Li, Shaojun Lyu, Yih-Kuen Jan.

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