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Abstract

Wheeled walkers (WWs) are used to improve mobility and for fall prevention in older persons, but not all users are satisfied with the usability of WWs. Intelligent WWs are being developed to improve the usability. The aim of this study was to support the development of intelligent WWs by investigating possible problems of using a WW. This study investigated 22 geriatric in-patients (median age 82 years) with and without their WW while opening a door against the direction of walking and passing through. Other possible problems when using WWs were identified by interview. Walking through the door was faster without than with using the WW (8.71 versus 12.86 s, p < 0.001), while interference between door and WW was documented in 41 of 44 (93 %) cases. Backward walking performance was better when using a WW with regard to gait speed, step width and walk ratio (all p < 0.002). Most referred problems when using a WW were walking downhill (83 %) and uphill (77 %) and obstacle crossing in general (77 %). Problems with opening a door against the direction of walking and the optimization of downhill and uphill walking as well as obstacle crossing should be regarded when developing an intelligent WW.
1 23
Aging Clinical and Experimental
Research
ISSN 1720-8319
Aging Clin Exp Res
DOI 10.1007/s40520-015-0410-8
Problems of older persons using a wheeled
walker
Ulrich Lindemann, Michael Schwenk,
Jochen Klenk, Max Kessler, Michael
Weyrich, Franziska Kurz & Clemens
Becker
1 23
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ORIGINAL ARTICLE
Problems of older persons using a wheeled walker
Ulrich Lindemann
1,2
Michael Schwenk
1,2
Jochen Klenk
1,2,3
Max Kessler
4
Michael Weyrich
2,4
Franziska Kurz
1
Clemens Becker
1,2
Received: 2 March 2015 / Accepted: 3 July 2015
ÓSpringer International Publishing Switzerland 2015
Abstract
Background Wheeled walkers (WWs) are used to
improve mobility and for fall prevention in older persons,
but not all users are satisfied with the usability of WWs.
Intelligent WWs are being developed to improve the
usability.
Aims The aim of this study was to support the develop-
ment of intelligent WWs by investigating possible prob-
lems of using a WW.
Methods This study investigated 22 geriatric in-patients
(median age 82 years) with and without their WW while
opening a door against the direction of walking and passing
through. Other possible problems when using WWs were
identified by interview.
Results Walking through the door was faster without than
with using the WW (8.71 versus 12.86 s, p\0.001), while
interference between door and WW was documented in 41
of 44 (93 %) cases. Backward walking performance was
better when using a WW with regard to gait speed, step
width and walk ratio (all p\0.002). Most referred prob-
lems when using a WW were walking downhill (83 %) and
uphill (77 %) and obstacle crossing in general (77 %).
Conclusions Problems with opening a door against the
direction of walking and the optimization of downhill and
uphill walking as well as obstacle crossing should be
regarded when developing an intelligent WW.
Keywords Door Older persons Usability Wheeled
walker
Introduction
Physical performance, such as balance while walking or
standing, decreases with age [1]. A wheeled walker (WW)
is frequently used to improve balance and mobility of older
persons [2,3] and to protect those persons from falling [4].
However, those persons falling while using a WW are more
likely to sustain a severe injury when falling, e.g., a hip
fracture [5]. Furthermore, walking performance has been
shown to decrease in a sub-population, i.e., Parkinson
´s
disease patients when using a WW [6]. In general, not all
users are satisfied with the WW and usability and acces-
sibility problems were identified as the main complaints
[7]. With regard to accessibility, opening doors against the
direction of walking and passing through is an obvious
problem. In this situation, the interference of the WW with
the door has to be managed while balance is challenged [8].
A side step could be an appropriate solution in this situa-
tion, but this has been shown to be associated with balance
problems when using a walker, which has limited func-
tionality for sideward movements [9]. To understand the
effect of a WW on gait and balance an assessment of a
daily activity, such as walking through a door, is
&Ulrich Lindemann
ulrich.lindemann@rbk.de
1
Department of Geriatrics and Clinic for Geriatric
Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110,
70376 Stuttgart, Germany
2
University Stuttgart Research Initiative Human Factors in
Ageing, Technology and Environment, Stuttgart, Germany
3
Institute of Epidemiology, Ulm University, Helmholzstr. 22,
89081 Ulm, Germany
4
Institute for Automation and Software Engineering,
University of Stuttgart, Pfaffenwaldring 47, 70569 Stuttgart,
Germany
123
Aging Clin Exp Res
DOI 10.1007/s40520-015-0410-8
Author's personal copy
recommended in combination with standard laboratory
measures [10].
Another approach to prevent interference of the door
with the WW is to walk backwards with the walking aid
while opening the door. However, backwards navigation of
most WWs is limited, due to fixed rear wheels. Only front
wheels are 360°rotatable for convenient navigation.
Backward walking without using an assistive device has
been investigated in different cohorts of age and perfor-
mance. A decrease in performance with age has been
shown with more walking performance deficits in fallers
than in non-fallers [11]. Although walking backwards with
a WW seems to be a frequent daily activity of older persons
with impaired walking performance. This phenomenon has
not been investigated so far.
Today smart technology is able to improve usability of
mechanical devices, such as a WW. Based on expert
opinion and possible technical solutions, intelligent walk-
ers are being developed focusing on obstacle avoiding,
powered impulsion and navigation technology [1214].
However, there was no identification of problems of the
users in advance and there is no evidence that these tech-
nical solutions are relevant for older persons using a WW.
Although smart walkers are probably the most studied aids
in the field of robotic assistance designed for disabled
individuals or persons at risk of disability, basic knowledge
about how and where WWs are helpful or not is still
lacking.
The aim of this study was to support the development of
intelligent WWs by investigating possible problems of
older adults while using a WW. We used typical real-life
scenarios including walking through a door and walking
backwards. We hypothesized that task difficulty increases
when passing through a door while using a WW reflected
by an increased ambulation time (versus without WW) and
interferences between WW and door. Furthermore, we
hypothesized that backward walking performance decrea-
ses while using a WW in comparison to walking without
WW. The rationale for this hypothesis is that here the WW
is not used according to the arrangement of the wheels. In
addition, it was aimed to identify other possible problems
when using a WW by conducting a semi-structured
interview.
Methods
Subjects and design
For the experimental part of this cross-sectional study 22
patients (median age 82 years, inter-quartile range
79–86.3 years, 50 % men) were recruited from a geriatric
rehabilitation clinic in the south–west of Germany. All
participants used their own WWs with 4 wheels, of which
the front wheels were 360°rotatable for navigation and the
rear wheels were fixed. Most of the participants (n=14;
64 %) were novice WW users and the mean duration of
usage of the remaining participants (n=8) was
33.1 months. They had to be able to walk forwards as well
as backwards with and without the WW for at least 5 m.
Exclusion criteria were unilateral functional impairment,
such as stroke or recent hip replacement and inability to
follow verbal instructions. The group is described in detail
in Table 1. The study was approved by the ethical com-
mittee of the University of Tu
¨bingen. All participants gave
written informed consent.
Outcome parameters and protocol
At a distance of 2.3 m, participants stood in front of a
standard door without any automatic function and opening
against the direction of walking. They were instructed to
walk to the door, open it, walk through the door and close it
all at their habitual pace. The task was performed with and
without WW in random order. Time to perform this task
was taken from a video and the faster of 2 trials was used as
outcome parameter. The number of interferences between
WW and door was recorded over all 44 trials. Interference
was defined as an interruption of the opening of the door,
caused by sideward or backward movement of the WW.
Rating from video was performed by 2 independent
investigators (UL, FK). After the experiment the partici-
pants were asked if passing through the door was easier
with or without using the WW.
In addition, participants walked at their own pace for-
wards with their WW over an instrumented walkway
(GAITRite
Ò
, CIR Systems, Haverton, USA) and thereafter
they walked backwards with and without WW in random
order. The mean of 2 trials was taken for analysis with gait
speed, step width and walk ratio, i.e., step length divided
by step frequency [15], as outcome parameters.
Table 1 Description of all 22 participants (50 % men) of the
experimental study
Median IQR Min–Max
Age (years) 82 79–86.3 73–90
Height (cm) 157.5 153.3–167.8 148–176
Weight (kg) 66.0 61.0–74.5 50–82
BMI (kg/m
2
) 26.3 22.7–28.5 20.3–33.7
Co-morbidities (n) 3 2–5 1–9
Chair Rise (n/30 s) 10.0 8.8–11.3 8–13
Habitual gait speed (m/s) 0.70 0.51–0.88 0.45–1.11
IQR inter-quartile range, BMI body mass index
Aging Clin Exp Res
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Descriptive parameters
Habitual gait speed (forward) and the number of sit-to-
stand transfers over 30 s at maximum pace [16] were used
as functional descriptive parameters. In the last named
assessment the protocol was modified that the use of
armrests was allowed. Furthermore, the older participants
were screened for co-morbidities by questionnaire [17]ina
standardized interview.
Statistics
Due to the small sample size median and inter-quartile
range (IQR), as well as non-parametric tests (Wilcoxon
rank-sum test) were used to describe parameters and dif-
ferences between conditions, respectively. The significance
level of all statistical procedures was set to a=5 % (two-
sided). All analyses were conducted using SPSS version 16
software (SPSS Inc., Chicago, IL, USA).
Interview
To identify possible problems when using a WW, a semi-
structured interview was conducted with 60 patients (mean
age 82.0 years, 67 % women) using a WW in the same
geriatric rehabilitation clinic. The cohort included 29
(48 %) first-time users, starting usage during in-patient
rehabilitation, and 31 (52 %) long-time users with a mean
usage of 30 months. We asked if they ever had experienced
a fall while using their WW. Problems were asked with
regard to walking in different directions, indoors and out-
doors, up- and downhill, in curves, through a door and on
the spot, over obstacles and on uneven surface, and with
regard to sitting on the WW and carrying things with the
WW, using the WW during the sit-to-stand transfer and
using the WW in different situations in the community,
attending doctor’s appointment, visiting friends or using
public transportation. An example of these questions is:
‘When you walk indoor with your WW, do you feel safe/
the device is helpful or do you feel unconfident/the device
is hindering?’’ If the participants opted unconfident/hin-
dering, the question was ‘‘What is the problem?’
Results
Walking through the door was faster without using the
WW than with using the WW (8.71 s, IQR 7.81–10.19
versus 12.86 s, IQR 10.76–14.29; p\0.001). Interference
between door and WW was documented in 41 of 44 (93 %)
cases with an example shown in Fig. 1. Directly after the
experiment, 13 (59 %) older adults rated walking through
the door without using the WW easier, for 6 patients
(27 %) there was no difference and 3 patients (14 %) rated
walking through the door with the use of their WW easier.
Walking forwards with the WW was performed faster,
with smaller step width and with a higher walk ratio than
walking backwards with WW. Walking backwards with
WW was performed faster, with smaller step width and
with a higher walk ratio than walking backwards without
WW. With regard to walking performance, all differences
between walking conditions were statistically significant
(all p\0.002) and are described in detail in Table 2.
Three out of 60 (5 %) patients had ever experienced a fall
while using their WW. Walking downhill (83 %) and uphill
(77 %) and walking outdoors over uneven ground (73 %) were
major problems identified by interview in the cohort of 60
patients using a WW. Obstacle crossing in general was a
problem for 77 % of a ll interviewed patients. Here, stairs in the
context of public transportation (70 %), leaving/entering the
own apartment (60 %) and doctors surgeries, visiting phar-
macies etc. (35 %) were a common problem. Also, walking
indoors (25 %) and outdoors (10 %) and carrying objects
indoors (7 %) and outdoors (10 %) while crossing obstacles
were further problems. Walking backwards with their WW
was a problem for 27 % of the patients. The problems during
walking and obstacle crossing are also shown in Fig. 2.
Fig. 1 Interference of the wheeled walker with the door during
opening against the direction of walking, showing not-rotatable back
wheels (1), rotatable front wheels (2) and a back wheel with lost
contact to the ground (3)
Aging Clin Exp Res
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A further problem identified by interview were the not-
rotatable back wheels which limited navigation during
walking sidewards (32 %), walking through a door (25 %)
and turning on the spot (15 %). With regard to using the
WW during the sit-to-stand transfer, 83 % of all patients
indicated not fixing the brakes as a major problem.
Discussion
This study identified serious problems when using a WW
during more complex walking tasks such as passing a door.
In contrast to straight walking, where no interference of the
WW with the environment occurs, motor performance
declined substantially during a complex mobility task
requiring sideward shifting. On the same note, this study
shows that a WW provides advantages during straight
backwards walking. Previous studies found similar results
for forward walking [2]. Our study results demonstrate pros
and cons of using a WW by combining the assessment of a
daily task and standard laboratory testing [10].
The longer time to walk through the door in our study is
likely an indicator of interference between WW and door.
Given a higher stability of walking performance when
using a WW [2], a longer time would be acceptable, but the
high number of interferences between WW and door points
out the incident of instability while opening and passing
through the door. Although our experimental result was
confirmed by the 59 % of patients, who rated walking
through the door to be easier without using a WW, the
awareness of this problem was less than half and likely
underestimated in our interviewed cohort. In our experi-
ment, the impossibility of a movement with the WW to the
side because of not-rotatable rear wheels is comparable to
Table 2 Walking performance
of all 22 participants (50 %
men) of the experimental study
Forward with WW
Median (IQR)
Backward with WW
Median (IQR)
Backward without WW
Median (IQR)
Gait speed (m/s) 0.70 (0.51–0.88) 0.36 (0.28–0.43) 0.31 (0.24–0.34)
Step width (cm) 8.1 (6.9–9.8) 16.1 (12.9–17.7) 20.7 (15.8–23.0)
Walk ratio 0.54 (0.47–0.60) 0.28 (0.22–0.40) 0.22 (0.16–0.28)
All differences between conditions were p\0.002
WW wheeled walker, IQR inter-quartile range
Fig. 2 Problems of older in-
patients (n=60) during
walking and problems with
obstacles when using the
wheeled walker
Aging Clin Exp Res
123
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the challenging situation when using a walker without
wheels [9]. One potential solution could be the imple-
mentation of smart technology. An intelligent WW, which
may be able to recognize its interference with a door
caused by, could release the fixation of its back wheels.
This way, the WW could be moved to the side, but still
provide assistance during walking in this balance chal-
lenging situation.
In our study, the decrease of walking performance
during backward walking was documented by slower gait
speed, broader step width and a smaller walk ratio, which is
associated with falls risk during forward walking [18].
Decreases in gait speed and step width are in line with
another study with a cohort of 62 older adults showing a
68 % faster backward walking gait speed, but walking
without an assistive device [11]. The limitation of visual
control while walking backwards may have caused these
changes in performance, which then can be regarded as a
necessary adaptation. Since the difference between for-
wards and backwards walking performance is considerable
in our study and in another study without using an assistive
device [11], the calculation of a forward/backward per-
formance ratio with and without WW may be helpful for
assessment of walking performance in older adults.
The use of the WW while walking backwards improved
walking performance, which is in line with the literature
based on forward walking [2]. Findings are contradictory to
our hypothesis. We expected that the WW would interfere
with the subjects
´ability to ambulate backwards due to the
reverse arrangement of the wheels. However, our results
show that gait performance was better during backwards
walking with WW reflected by a higher velocity and walk
ratio and reduced step with as compared to waling without
WW. Furthermore, our results indicate an overestimation of
problems during backward walking in our interview cohort.
The results of our interview-based identification of
problems when using a WW, which are partly confirmed by
the result of our experimental study, may help to develop
an intelligent WW. Here, the support and deceleration
during uphill and downhill walking, respectively, a case
sensitive release of the rear wheels and a support for
obstacle crossing may be relevant issues. In addition, our
results may help designing a test protocol to show the
advantages of intelligent WWs during real-life situations
which were identified as problematic in the present study.
Another aspect of using intelligent WWs could be moni-
toring specific parameters related to mobility-related
quality of life and health. For instance, the walking dis-
tance per day, an important marker of physical activity
level, could be easily measured by adding simple tech-
nology. Furthermore, vertical force applied at the handle
could be measured to estimate upper extremity weight
bearing, which might be a parameter for monitoring
rehabilitation progress. Also, detection of a WW in hori-
zontal, i.e., lying position, could indicate a fall, which in
turn could initiate an alarm call.
As a limitation of our study, the small sample size
makes it hard to generalize our results. Nevertheless, a
small sample size is rather expected to provide statistical
trends than clear results, as in the experimental part of our
study. Furthermore, only one of the several problems
identified by our interviews was approached in the exper-
imental part of our study. Future studies should investigate
more of these problems to provide issues worth to be
solved by an intelligent walker.
In conclusion, opening a door against the direction of
walking caused interference between WW and, door and
was identified as one problem when using a WW. Devel-
oping an intelligent WW, this possible safety problem
should be regarded. In contrast, backward walking per-
formance was improved by using a WW. For evaluation of
future intelligent WWs, a combination of task specific tests
and standard laboratory tests is recommended.
Acknowledgments The authors thank Aaron Haslbauer, Karin
Kampe and Elisabeth Petrias for data collection and technical support
and the authors thank Aileen Currie for proofreading the manuscript.
Compliance with ethical standards
Conflict of interest This work was supported by the Robert Bosch
Foundation as the owner of the Robert-Bosch-Hospital where the
study was conducted. The authors declare that they have no conflict of
interest.
Ethical standards All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional research committee and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.
Informed consent Informed consent was obtained from all indi-
vidual participants included in the study.
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... The risks for falls are manifold and mainly related to prior history of falls, functional impairment, use of walking aids, cognitive impairment or dementia, impaired mobility or low activity level, balance abnormalities, medications, and low muscle strength [4]. The use of a walking aid is a surrogate for poor walking performance [5][6][7]. Nevertheless, it seems paradox to refer walking aids to risk factors for falls, as they are supposed to increase users' base of support and improve balance performance. Rollators are particularly prescribed to improve postural stability in patients with muscular weaknesses and balance impairments. ...
... Nine studies used the GAITRite® measurement system [2,7,21,23,24,[27][28][29]31]. In two studies an inertial sensor (Shimmer 2R) was additionally placed on the foot to collect data [2,28]. ...
... In one study, the rollator was instrumented with four single axis load cells (Futek LCM300, FUTEK Advanced Sensor Technology Inc., Irvine, California) and corresponding transmitters (Mantracourt T24-ACMi, Mantracourt Electronics Ltd., Exeter, UK). Additionally, a pressure-sensing insole system (Medilogic insole, T&T Medilogic Medizintechnik GmbH, Schönefeld, Germany) was used [7]. ...
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Background: The aging population increasingly needs assistive technologies, such as rollators, to function and live less dependently. Rollators are designed to decrease the risk of falls by improving the gait mechanics of their users. However, data on the biomechanics of rollator assisted gait of older adults are limited, or mostly derived from experiments with younger adults. Methods and results: This review summarises the data from 18 independent studies on the kinematic and kinetic gait parameters of assisted gait of older persons. All of these studies evaluated spatio-temporal parameters, but not joint angles or moments. Conclusion: Due to the limited research on rollator supported gait in older adults, the number of parameters that could be analysed in this systematic review was restricted. Further research in the analysis of spatio-temporal parameters and a higher standardisation in clinical research will be necessary.
... Many wheeled walkers have important limitations, such as the need to decrease gait speed when bypassing an obstacle or when there is the need to change direction [12]. The elderly person may not have enough strength or balance to control or stop the walker by him/herself. ...
... Two sliding blocks, one interior (7) and other exterior (13), matching the part surface, ensure the correct position of the wheel, allowing the necessary axial sliding of the new feature. The compression spring (11) is blocked in the lower extremity with a stopper fixed inside (12). This stopper has a through hole with the same diameter of the shaft, which holds it in the proper position. ...
... Satisfaction was also assessed with the previously mentioned questionnaire. According to Figure 7, the ETGUG allowed for the evaluation of (1) activity duration, (2) reverse walking speed for a total distance of 20 meters, and (3) energy expenditure using the PCI formula [12]. by automatic blocking of the system when certain pressure occurs. ...
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Background: The ageing process involves a natural degeneration of physiological function and can imply life constraints, namely during activities of daily life (ADL). Walking can be strongly affected by strength, gait, and balance changes, which affect quality of life. The quality of life of the older adult is associated with available solutions that contribute to an active and safe ageing process. Most of these solutions involve technical aids that should be adapted to older adults’ conditions. Aim: To identify the advantages and disadvantages of two-wheeled walkers and of two different self-locking systems designed and developed by the authors. Methods: Two studies were performed based on the possible walker combinations used, using a walker with no wheels (classic fixed walker), a two-wheeled walker with self-locking mechanism made of gears and a spring (Approach 1), and a two-wheeled walker with a self-locking mechanism which uses a single spring (Approach 2). These combinations were tested in two quasi-experimental studies with pre–post test design. Results: No significant differences in duration, gait speed, and Expanded Timed Get Up and Go (ETGUG) were found between the walkers, but there was a marginally significant difference in Physiological Cost Index (PCIs), which means that the energetic cost with Approach 1 was greater than that with Approach 2. Users reported a feeling of insecurity and more weight, although no significant differences were observed and they were found to be equivalent in terms of safety. Study 2 found an improvement in duration and gait speed in the ETGUG between the different types of self-locking systems. Conclusions: The PCI is higher in the two-wheeled walker models and with the self-locking mechanism. Approach 2 did not show better conditions of use than the other two walkers, and participants did not highlight its braking system. Although safety is similar among the three walkers, further studies are needed, and the braking system of the two-wheeled walker needs to be improved (Approach 2).
... [12,13]. In addition accessibility issues are also a concern, Lindemann et al. identi ed opening a door against the direction of walking and obstacle clearance as the biggest problem for older adults using a 4-wheeled walker [14]. In the absence of professional input, the mobility aid may not appropriately compensate for de cits in balance and gait, and the person with dementia not necessarily receive training on safe use of the equipment. ...
... Speci cally, there was an increased risk of falls when transferring to use the mobility aid and there were safety concerns of not appropriately using the prescribed device. Our assessment tool includes the assessment of transitions between sitting and standing, and the challenges identi ed by Lindemann et al. [14] of manoeuvring the walker when navigating doors that open away and towards people. ...
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Background: Balance and gait problems are common and progressive in dementia. Mobility aid use in people with dementia increases the likelihood of falls three-fold. An assessment tool to quantify mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safety with use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change. Methods: Healthcare professionals (HCP) experienced in care and rehabilitation of people with dementia participated in focus groups for item generation of the new tool, entitled The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Ten individuals with dementia using a 4-wheeled walker were recorded performing the tasks within the SUMAC. Reliability was evaluated by having five HCP score participant videos on two occasions. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity was evaluated using scores determined by a consensus panel compared to the individual HCP scores using Spearman’s rank-order correlations. Criterion validity was assessed between SUMAC-PF and the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman’s rank-order correlations. Results: Three focus groups (n=17) were completed and these generated a tool comprised of nine tasks and the components within each task that the clinicians would observe for physical function and safe use. Inter-rater reliability was statistically significant for the SUMAC-PF (ICC=0.92, 95%CI (0.81, 0.98), p<0.001) and SUMAC-EQ (ICC=0.82, 95%CI (0.54, 0.95), p<0.001). Test-retest reliability was also statistically significant for the SUMAC-PF (ICC=0.89, 95%CI (0.81, 0.94), p<0.001) and SUMAC-EQ (ICC=0.88, 95%CI (0.79, 0.93), p<0.001). The POMA gait subscale correlated strongly with the SUMAC-PF (r=0.84), but not EQ (r=0.39). Conclusions: Each of the scores of the SUMAC, physical function and safe use of the equipment, demonstrated content validity, strong inter-rater and test-retest reliability and strong criterion and concurrent validity for the assessment of mobility aid safety in people with dementia.
... [12,13]. In addition accessibility issues are also a concern, Lindemann et al. identified opening a door against the direction of walking and obstacle clearance as the biggest problem for older adults using a 4-wheeled walker [14]. In the absence of professional input, the mobility aid may not appropriately compensate for deficits in balance and gait, and not necessarily receive training on safe use of the equipment. ...
... Specifically, there was an increased risk of falls when transferring to use the mobility aid and there were safety concerns of not appropriately using the prescribed device. Our assessment tool includes the assessment of transitions between sitting and standing, and the challenges identified by Lindemann et al. [14] There are some limitations that should be noted. The SUMAC was created solely for the assessment of 4-wheeled walker use and thus the tool is not applicable to canes or crutches. ...
Preprint
Full-text available
Background Balance and gait problems are common and progressive in dementia. Mobility aid use in people with dementia increases the likelihood of falls three-fold. An assessment tool to quantify mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safety with use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change. Methods Healthcare professionals (HCP) experienced in care and rehabilitation of people with dementia participated in focus groups for item generation of the new tool, entitled The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Ten individuals with dementia using a 4-wheeled walker were recorded performing the tasks within the SUMAC. Reliability was evaluated by having five HCP score participant videos on two occasions. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity was evaluated using scores determined by a consensus panel compared to the individual HCP scores using Spearman’s rank-order correlations. Criterion validity was assessed between SUMAC-PF and the Performance-Oriented Mobility Assessment (POMA) using Spearman’s rank-order correlations. Results Three focus groups (n=17) were completed and these generated a tool comprised of nine tasks and the components within each task that the clinicians would observe for physical function and safe use. Inter-rater reliability was statistically significant for the SUMC-PF (ICC=0.72, 95%CI (0.33-0.92), p
... Considering these recommendations, and acknowledging that the rear legs do not have wheels and hence at times may need lifting, we infer correct use to be that the front wheels should remain grounded. However, leaflets generally fail to address how to use the frame when performing more complex tasks, for example crossing obstacles such as door thresholds and turning in confined spaces, despite users reporting a range of everyday tasks as problematic [11]. It therefore remains doubtful whether current guidance is adequately adhered to in the home environment, and whether following current guidance indeed facilitates safe everyday use of walking aids. ...
... to 64 (severe concerns about falling). Participants lived in residential housing [3], sheltered housing [3], or care homes [11]. Ethical approval was sought and granted from the University of Salford's Ethics Committee (HSCR16/35, HSCR13/48) and the London Dulwich Research Ethics Committee (16/LO/0986). ...
Article
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Background: Walking aids are issued to older adults to prevent falls, however, paradoxically their use has been identified as a risk factor for falling. To prevent falls, walking aids must be used in a stable manner, but it remains unknown to what extent associated clinical guidance is adhered to at home, and whether following guidance facilitates a stable walking pattern. It was the aim of this study to investigate adherence to guidance on walking frame use, and to quantify user stability whilst using walking frames. Additionally, we explored the views of users and healthcare professionals on walking aid use, and regarding the instrumented walking frames ('Smart Walkers') utilized in this study. Methods: This observational study used Smart Walkers and pressure-sensing insoles to investigate usage patterns of 17 older people in their home environment; corresponding video captured contextual information. Additionally, stability when following, or not, clinical guidance was quantified for a subset of users during walking in an Activities of Daily Living Flat and in a gait laboratory. Two focus groups (users, healthcare professionals) shared their experiences with walking aids and provided feedback on the Smart Walkers. Results: Incorrect use was observed for 16% of single support periods and for 29% of dual support periods, and was associated with environmental constraints and a specific frame design feature. Incorrect use was associated with reduced stability. Participants and healthcare professionals perceived the Smart Walker technology positively. Conclusions: Clinical guidance cannot easily be adhered to and self-selected strategies reduce stability, hence are placing the user at risk. Current guidance needs to be improved to address environmental constraints whilst facilitating stable walking. The research is highly relevant considering the rising number of walking aid users, their increased falls-risk, and the costs of falls.
... However, rollator users have also reported challenges associated with outdoor use. In a recent study [9] in which 60 four-wheeledrollator users were interviewed, it was shown that users reported problems when walking downhill and uphill, during obstacle crossing and when walking over uneven ground. In addition, use of rollators may not necessarily help the rollator users to complete complex walking tasks, for example, opening a door against the walking direction [9]. ...
... In a recent study [9] in which 60 four-wheeledrollator users were interviewed, it was shown that users reported problems when walking downhill and uphill, during obstacle crossing and when walking over uneven ground. In addition, use of rollators may not necessarily help the rollator users to complete complex walking tasks, for example, opening a door against the walking direction [9]. A subsequent laboratory study showed that the quality of walking was improved when using a rollator compared to walking unaided, but the quality of walking with rollator was reduced during uphill and downhill walking compared to level walking. ...
Article
Rollators are widely used by people with mobility problems, but previous studies have been limited to self-report approaches when evaluating their real world effectiveness. To support studies based on more robust datasets, a method to estimate mobility parameters, such as gait speed and distance travelled, in the real world is needed. Body-worn sensors offer one approach to the problem, but rollator-mounted sensors have some practical advantages providing direct insight into patterns of walking device use, an under-researched area. We present a novel method to estimate speed and distance travelled from a single rollator-mounted IMU. The method was developed using data collected from ten rollator users performing a series of walking tasks, including obstacle negotiation. The IMU data is first pre-processed to account for noise, orientation offset and rotation-induced accelerations. The method then uses a two stage approach. First, activity classification is used to separate the rollator data into one of three classes (movement, turning or other). Subsequently, the speed of movement and distance travelled is estimated, using a separate estimation model for each of the three classes. The results showed high classification accuracy (precision, recall and F1 statistics all >0.9). Speed estimation showed mean absolute errors below 0.2 m/s. Estimates for distance travelled showed errors which ranged from 5showed some promise, but further work with a larger data set is needed to confirm the performance of our approach.
... Hindernissen während des Gehens auszuweichen oder sie angemessen überwinden zu können, stellt somit eine wichtige Fähigkeit für die sichere Fortbewegung im Alltag dar. Mit zunehmendem Alter nimmt diese Fähigkeit jedoch ab (Chen, Ashton-Miller, Alexander & Schultz, 1991Weerdesteyn, Nienhuis & Duysens, 2005) (Lindemann et al., 2016) und dass Kollisionen mit Hindernissen in der Umgebung zu Frustration sowie Ärger führen können (Brandt, Iwarsson & Stahl, 2003 Sitzen-Stehen-Transfer (STS) Williamson & Fried, 1996), die mit einem erhöhten Sturzrisiko sowie einem Verlust der Mobilität, Selbstständigkeit und Lebensqualität assoziiert sind wurde verwendet, um die Benutzerzufriedenheit mit den drei unterschiedlichen Betriebsmodi zu erfassen Einen ähnlich positiven Effekt eines in einen robotergestützten Rollator integrierten Navigationssystems wurde in einer früheren Studie berichtet oder die Teststärke war zu gering, um einen statistisch signifikanten Effekt der Hindernisvermeidung zu erzielen . Kim et al., 2012;. ...
Thesis
Ziel der vorliegenden Arbeit ist die nutzerorientierte Evaluation zweier Prototypen für altersgerechte Assistenzroboter zur Unterstützung von Alltagsaktivitäten („Ambient Assisted Living“ [AAL]-Roboter) bei älteren Menschen mit funktionellen Einschränkungen. Bei den Prototypen handelt es sich dabei um (1) einen robotergestützten Rollator zur Unterstützung der Mobilität (MOBOT) und (2) einen Assistenzroboter zur Unterstützung von Duschaktivitäten (I-SUPPORT). Manuskript I dokumentiert eine systematische Literaturanalyse des methodischen Vorgehens bisheriger Studien zur Evaluation robotergestützter Rollatoren aus der Nutzerperspektive. Die meisten Studien zeigen erhebliche methodische Mängel, wie unzureichende Stichprobengrößen/-beschreibungen; Teilnehmer nicht repräsentativ für die Nutzergruppe der robotergestützten Rollatoren; keine geeigneten, standardisierten und validierten Assessmentmethoden und/oder keine Inferenzstatistik. Ein generisches methodisches Vorgehen für die Evaluation robotergestützter Rollatoren konnte nicht identifiziert werden. Für die Konzeption und Durchführung zukünftiger Studien zur Evaluation robotergestützter Rollatoren, aber auch anderer AAL-Systeme werden in Manuskript I abschließend Handlungsempfehlungen formuliert. Manuskript II analysiert die Untersuchungsergebnisse der in Manuskript I identifizierten Studien. Es zeigen sich sehr heterogene Ergebnisse hinsichtlich des Mehrwerts der innovativen Assistenzfunktionen von robotergestützten Rollatoren. Im Allgemeinen werden sie jedoch als positiv von den Nutzern wahrgenommen. Die große Heterogenität und methodischen Mängel der Studien schränken die Interpretierbarkeit ihre Untersuchungsergebnisse stark ein. Insgesamt verdeutlicht Manuskript II, dass die Evidenz zur Effektivität und positiven Wahrnehmung robotergestützter Rollatoren aus der Nutzerperspektive noch unzureichend ist. Basierend auf den Erkenntnissen und Handlungsempfehlungen der systematischen Literaturanalysen aus Manuskript I und II wurden die nutzerorientierten Evaluationsstudien des MOBOT-Rollators konzipiert und durchgeführt (Manuskript III-VI). Manuskript III überprüft die Effektivität des in den MOBOT-Rollator integrierten Navigationssystems bei potentiellen Nutzern (= ältere Personen mit Gangstörungen bzw. Rollator als Gehhilfe im Alltag). Es liefert erstmals einen statistischen Nachweis dafür, dass eine solche Assistenzfunktion effektiv ist, um die Navigationsleistung der Nutzer (z. B. geringer Stoppzeit, kürzere Wegstrecke) – insbesondere derjenigen mit kognitiven Einschränkungen – in einem realitätsnahen Anwendungsszenario zu verbessern. Manuskript IV untersucht die konkurrente Validität des MOBOT-integrierten Ganganalysesystems bei potentiellen Nutzern. Im Vergleich zu einem etablierten Referenzstandard (GAITRite®-System) zeigt es eine hohe konkurrente Validität für die Erfassung zeitlicher, nicht jedoch raumbezogener Gangparameter. Diese können zwar ebenfalls mit hoher Konsistenz gemessen werden, aber lediglich mit einer begrenzten absoluten Genauigkeit. Manuskript V umfasst die nutzerorientierte Evaluation der im MOBOT-Rollator integrierten Assistenzfunktion zur Hindernisvermeidung und belegt erstmals die Effektivität einer solchen Funktionen bei potentiellen Nutzern. Unter Verwendung des für den MOBOT-Rollator neu entwickelten technischen Ansatzes für die Hindernisvermeidung zeigten die Teilnehmer signifikante Verbesserungen bei der Bewältigung eines Hindernisparcours (weniger Kollisionen und geringere Annäherungsgeschwindigkeit an die Hindernisse). Manuskript VI dokumentiert die Effektivität und Zufriedenheit mit der Aufstehhilfe des MOBOT-Rollators von potentiellen Nutzern. Es wird gezeigt, dass die Erfolgsrate für den Sitzen-Stehen-Transfer älterer Personen mit motorischen Einschränkungen durch die Aufstehhilfe signifikant verbessert werden kann. Die Ergebnisse belegen zudem eine hohe Nutzerzufriedenheit mit dieser Assistenzfunktion, insbesondere bei Personen mit höherem Body-Mass-Index. Manuskript VII untersucht die Mensch-Roboter-Interaktion zwischen dem I-SUPPORT-Duschroboter und seiner potentiellen Nutzer (= ältere Personen mit Problemen bei Baden/Duschen) und überprüft deren Effektivität sowie Zufriedenheit mit drei unterschiedlich autonomen Betriebsmodi. Die Studienergebnisse dokumentieren, dass sich mit zunehmender Kontrolle des Nutzers (= abnehmende Autonomie des Duschroboters) nicht nur die Effektivität für das Abduschen eines definierten Körperbereichs verringert, sondern auch die Nutzerzufriedenheit sinkt. Manuskript VIII umfasst die Evaluation eines spezifischen Nutzertrainings auf die gestenbasierte Mensch-Roboter-Interaktion mit dem I-SUPPORT-Duschroboter. Es wird gezeigt, dass ein solches Training die Ausführung der Gesten potentieller Nutzer und sowie die Gestenerkennungsrate des Duschroboters signifikant verbessern, was insgesamt auf eine optimierte Mensch-Roboter-Interaktion in Folge des Trainings schließen lässt. Teilnehmer mit der schlechtesten Ausgangsleistung in der Ausführung der Gesten und mit der größten Angst vor Technologien profitierten am meisten vom Nutzertraining. Insgesamt belegen die Studienergebnisse zur nutzerorientierten Evaluation des MOBOT-Rollators die Effektivität und Gültigkeit seiner innovativen Teilfunktionen. Sie weisen auf ein hohes Potential der Assistenzfunktionen (Navigationssystem, Hindernisvermeidung, Aufstehhilfe) zur Verbesserung der Mobilität älterer Menschen mit motorischen Einschränkungen hin. Vor dem Hintergrund der methodischen Mängel und unzureichenden evidenzbasierten Datenlage hierzu, liefert diese Dissertationsschrift erstmals statistische Belege für den Mehrwert solcher Teilfunktionen bei potentiellen Nutzern und leistet somit einen wichtigen Beitrag zur Schließung der bisherigen Forschungslücke hinsichtlich des nutzerorientierten Wirksamkeits- und Gültigkeitsnachweises robotergestützter Rollatoren und ihrer innovativen Teilfunktionen. Die Ergebnisse der Studien des I-SUPPORT-Duschroboters liefern wichtige Erkenntnisse hinsichtlich der Mensch-Roboter-Interaktion im höheren Alter. Sie zeigen, dass bei älteren Nutzern für eine effektive Interaktion Betriebsmodi mit einem hohen Maß an Autonomie des Duschroboters notwendig sind. Trotz ihrer eingeschränkten Kontrolle über den Roboter, waren die Nutzer mit dem autonomsten Betriebsmodus sogar am zufriedensten. Darüber hinaus unterstreichen die Ergebnisse hinsichtlich der gestenbasierten Interaktion mit dem I-SUPPORT-Duschroboter, dass zukünftige Entwicklungen von altersgerechten Assistenzrobotern mit gestenbasierter Interaktion nicht nur die Verbesserungen technischer Aspekte, sondern auch die Sicherstellung und Verbesserungen der Qualität der Nutzergesten für die Mensch-Roboter-Interaktion durch geeignete Trainings- oder Schulungsmaßnahmen berücksichtigen sollten. Das vorgestellte Nutzertraining könnte hierfür ein mögliches Modell darstellen.
... Theoretically, a walking speed of up to 2 m s −1 (=10 cm/50 ms) or 7.2 km h −1 can be captured. This is in an acceptable range [24][25][26][27][28], especially as the operation of the door reduces the walking speed. ...
Article
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The duration of patient–physician contact is an important factor for the optimisation of treatment processes in healthcare systems. Available methods can be labour-intensive and the quality is, in many cases, poor. A part of this research project is to develop a sensor system, which allows the detection of people passing through a door, including the direction. For this purpose, two time of flight sensors are combined with a door sensor and a motion detection sensor (for redundancy) on one single side of the door frame. The period between two single measurements could be reduced to 50 ms, which allows the measurement of walking speed up to 2 ms − 1 . The accuracy of the time stamp for each event is less than one second and ensures a precise documentation of the consultation time. This paper presents the development of the sensor system, the miniaturisation of the installation and first measurement results, as well as the measurement’s concept of quality analysis, including multiple door applications. In future steps, the sensor system will be deployed at different medical practices to determine the exact duration of the patient–physician interaction over a longer time period.
... Although it does not result in a complete relief of the muscles of the lower extremities, ankles and knees are significantly relieved. Lindemann et al. [16] examined 22 geriatric patients (age median 82 years) who performed various everyday movements with and without a rollator. While some movements were performed faster without a walker (e.g., walking through a door that opens towards the user), other movements could be executed much more quickly and safely with the walker (e.g., walking backwards). ...
Conference Paper
People who suffer from difficulties in ambulating can be supported by using wheeled walking frames, also called rollators. Mechanical rollators are very helpful and provide physical stability but their functionality is limited. Electro-powered rollators can support the user whenever motor power is needed, e.g., when walking uphill or crossing the curbside of a sidewalk. The full potential of electric and smart rollators is not yet used. In this paper, we describe a new Robotic Rollator (RoRo) concept. The aim of RoRo is to guide elderly people autonomously through clinics and rehabilitation homes, e.g., to lead them to the radiology department or to the physiotherapist's office. Furthermore, RoRo trains the elderly and examines their mobility, stability, and strength, as well as their visual-spatial and cognitive abilities. For this purpose, RoRo is equipped with additional sensors to monitor vital data of the user and to relate them to the physical load. The autonomous rollator RoRo interacts in the closed controlled indoor environments with infrared markers (that cannot be seen by humans) to allow spatial positioning. In addition to the technological aims of RoRo, another focus of the ongoing project lies on a balanced interaction between RoRo and the patient to motivate therapeutic exercises, physical activity (like going for a walk), and simple entertainment. In the future, the autonomous rollator may become a social robot that trains and accompanies the user like a personal acquaintance.
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Background With ageing populations worldwide, mobility devices are used more than ever. In the current literature there is no consensus whether the available mobility devices safely improve the mobility of their users. Also, evidence is lacking concerning the risks and types of injuries sustained while using a four-wheeled walker. Objective To assess injury risks and injury patterns in older adults (≥65 years) who presented at Emergency Departments (ED) in the Netherlands with an injury due to using a four-wheeled walker. Design and setting In this study, the Dutch Injury Surveillance System was used to obtain a national representative sample of annual ED visits in the Netherlands in the adult population (≥65 years) sustaining an injury while using a four-wheeled walker. The numbers of four-wheeled walker users in the Netherlands were obtained from the national insurance board. The numbers of ED visits were divided by the numbers of four-wheeled walker users to calculate age- and sex-specific injury risks. Results Annually 1869 older adults visited an ED after sustaining an injury while using a four-wheeled walker. Falls were the main cause of injury (96%). The injury risk was 3.1 per 100 users of four-wheeled walkers. Women (3.5 per 100 users) had a higher risk than men (2.0 per 100 users). Injury risk was the highest in women aged 85 years and older (6.2 per 100 users). The majority of injuries were fractures (60%) with hip fracture (25%) being the most common injury. Nearly half of all four-wheeled walker related injuries required hospitalisation, mostly due to hip fractures. Healthcare costs per injury were approximately €12 000. Conclusions This study presents evidence that older adults experiencing a fall while using a four-wheeled walker are at high risk to suffer severe injuries.
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To investigate the relationship between fast-walking and falls in older people. Individuals aged 60-86 years were randomly selected from the electoral roll (n=176). Gait speed, step length, cadence and a walk ratio were recorded during preferred- and fast-walking using an instrumented walkway. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait variables during fast-walking and change between preferred- and fast-walking. Covariates included age, sex, mood, physical activity, sensorimotor and cognitive measures. The risk of multiple falls was increased for those with a smaller walk ratio (shorter steps, faster cadence) during fast-walking (RR 0.92, CI 0.87, 0.97) and greater reduction in the walk ratio (smaller increase in step length, larger increase in cadence) when changing to fast-walking (RR 0.73, CI 0.63, 0.85). These gait patterns were associated with poorer physiological and cognitive function (p<0.05). A higher risk of multiple falls was also seen for those in the fastest quarter of gait speed (p=0.01) at fast-walking. A trend for better reaction time, balance, memory and physical activity for higher categories of gait speed was stronger for fallers than non-fallers (p<0.05). Tests of fast-walking may be useful in identifying older individuals at risk of multiple falls. There may be two distinct groups at risk--the frail person with short shuffling steps, and the healthy person exposed to greater risk.
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To study immediate gait changes in persons with PD when walking with different assistive walking devices. Ten individuals with idiopathic PD participated in the study. Gait parameters were recorded while walking with a cane and a wheeled walker, and were compared to a free walk without a walking device. Persons with PD walked with slower gait speed when using a cane and a wheeled walker compared to walking without any device (p = 0.007, p = 0.002, respectively). Stride length reduced significantly when walking with a wheeled walker (p = 0.001). Walking with the assistive devices did not affect cadence, double support phase, heel to heel base of support, stride time, and stance period. Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker. The results may lead to more cautious clinical practice in gait rehabilitation using ambulatory assisted devices.
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To determine the effectiveness of mobility device interventions in terms of activity and participation for people with mobility limitations. Systematic review. Search of 7 databases during the period 1996 to 2008. Controlled studies and non-controlled follow-up studies were included if they covered both baseline and follow-up data and focused on activity and participation. Study participants had to be aged over 18 years with mobility limitations. Mobility device interventions encompassed crutches, walking frames, rollators, manual wheelchairs and powered wheelchairs (including scooter types). Two reviewers independently selected the studies, performed the data extraction, and 4 reviewers assessed the studies' methodological quality. Disagreements were resolved by consensus. Eight studies were included: one randomized controlled trial, 4 controlled studies, and 3 follow-up studies that included before and after data. Two studies dealt with the effects of powered wheelchair interventions and the other studies with various other types of mobility device. Two studies were of high, internal and external methodological quality. Interventions were found to be clinically effective in terms of activity and participation in 6 studies. The results did not, however, give a unanimous verdict on the effectiveness of mobility devices in enhancing the activity and participation of mobility impaired people. Interventions and outcome measurement methods varied between the studies; consequently, it was not possible to draw any general conclusions about the effectiveness of mobility device interventions. However, evidence was found that mobility devices improve users' activity and participation and increase mobility. A lack of high-quality research hampers conclusions about effectiveness. More original, well-designed research is required.
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Measuring lower body strength is critical in evaluating the functional performance of older adults. The purpose of this study was to assess the test-retest reliability and the criterion-related and construct validity of a 30-s chair stand as a measure of lower body strength in adults over the age of 60 years. Seventy-six community-dwelling older adults (M age = 70.5 years) volunteered to participate in the study, which involved performing two 30-s chair-stand tests and two maximum leg-press tests, each conducted on separate days 2-5 days apart. Test-retest intraclass correlations of .84 for men and .92 for women, utilizing one-way analysis of variance procedures appropriate for a single trial, together with a nonsignificant change in scores from Day 1 testing to Day 2, indicate that the 30-s chair stand has good stability reliability. A moderately high correlation between chair-stand performance and maximum weight-adjusted leg-press performance for both men and women (r = .78 and .71, respectively) supports the criterion-related validity of the chair stand as a measure of lower body strength. Construct (or discriminant) validity of the chair stand was demonstrated by the test's ability to detect differences between various age and physical activity level groups. As expected, chair-stand performance decreased significantly across age groups in decades--from the 60s to the 70s to the 80s (p < .01) and was significantly lower for low-active participants than for high-active participants (p < .0001). It was concluded that the 30-s chair stand provides a reasonably reliable and valid indicator of lower body strength in generally active, community-dwelling older adults.
Article
Purpose: Despite the common use of rollators (four-wheeled walkers), understanding their effects on gait and balance is limited to laboratory testing rather than everyday use. This study evaluated the utility of an ambulatory assessment approach to examine balance and mobility in everyday conditions compared to a laboratory assessment. Methods: Standing and walking with a rollator was assessed in three neurological rehabilitation in-patients under two conditions: (1) in laboratory (i.e. forceplate, GaitRite), and (2) while performing a natural walking course within and outside of the institution. An instrumented rollator (iWalker) was used to measure variables related to the balance control (e.g. upper limb kinetics), destabilizing events (e.g. stumbling), and environmental context. Results: Two of three patients demonstrated greater reliance on the rollator for standing balance (2.3-5.9 times higher vertical loading, 72-206% increase in COP excursion) and 29-42% faster gait during the walking course compared to the laboratory. Importantly, destabilizing events (collisions, stumbling) were recorded during the walking course. Such events were not observed in the laboratory. Conclusion: This study illustrated a greater reliance on the rollator during challenges in everyday use compared to laboratory assessment and provided evidence of specific circumstances associated with destabilizing events that may precipitate falls in non-laboratory settings. Implications for Rehabilitation The value of combining laboratory and ambulatory assessment approaches to provide a more comprehensive profile of the risks and benefits of rollator use to prevent falling was studied. Patients demonstrated greater reliance on rollator assistive devices for standing balance and exhibited higher gait speeds during ambulatory assessment, compared to standard laboratory protocols. Repeated instances of events that may precipitate falls (e.g. collisions, stumbling, and unloading behaviors) were observed only during the ambulatory assessment. Individual challenges to balance can be used to identify specific training targets, assess suitability for assistive devices, and recommend rehabilitation goals.
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Many falls occur from backward perturbations or during transitional movements that require a person to turn and step backwards, suggesting that deficits in backward stepping may negatively impact mobility. Previous studies found significant declines in backward walking (BW) spatiotemporal measures in healthy elderly compared to young adults. No studies to date have examined BW performance in middle-aged adults and in elderly with impaired mobility. This study compared spatiotemporal measures of BW and forward walking (FW) in young, middle-aged, and elderly and in elderly fallers and non-fallers; and compared the strength of the relationship between age and BW and FW spatiotemporal measures to determine the utility of BW performance as a clinical tool for examining safety and mobility. BW measures were significantly more impaired in the elderly (n=62) compared to young (n=37) and middle-aged (n=31) adults and age effects were greater in BW than FW. No significant differences were found between young and middle-aged except for base of support in BW. Stronger correlations were found between age and BW measures than between age and FW measures, particularly correlations between age and BW velocity and stride length. Elderly fallers had greater deficits in BW performance than non-fallers. All elderly fallers had BW velocities <.6m/s. Clinicians are encouraged to assess BW, particularly BW velocity, as part of mobility examinations.
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To determine the effect of modifying the stable visual anchor on the postural stability of older individuals. The visual anchor was changed by opening doors similar to those found in an elevator cage. Lighting intensities inside and outside the cage were varied to create increasing or decreasing luminosity conditions. The effect of adding a cognitive load (counting backwards) was also tested. A controlled laboratory study. Tests performed in a balance laboratory. Sensory and clinical measurements to insure the integrity of the central and peripheral nervous system. Measures of balance were derived from the recordings of the center of foot pressure. These measures included range and speed of the center of foot pressure. Eight older, community-dwelling subjects and nine young subjects participated. A sensorimotor evaluation was used to insure that all older individuals were free from any pathologies affecting postural stability. All participants had a low score (indicating high balance confidence) on the Falls Efficacy Scale and no history of falls. Older individuals were affected by modification of the stable visual anchor induced by the opening of doors similar to that of an elevator cage. They showed greater ranges of the center of foot pressure (COP) and speed of the COP after than before the opening of the doors. Furthermore, the increased ranges and speed were two to three times greater than that observed for the young subjects. A lighting intensity considered as comfortable for reading inside the elevator affected the overall postural stability of the older participants negatively. Counting backwards also decreased their overall stability. Changing the stable visual anchor, as when exiting an elevator cage, could be a significant risk factor for older persons. Moreover, when combined with a cognitive load or lower lighting intensity inside the elevator cage, the negative effects on the postural stability of older persons are exacerbated.
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The walk ratio, step-length divided by step-rate, is a speed-independent index of walking patterns. This study reports on the reproducibility of the walk ratio in repeated tests. A total of 25 healthy young subjects walked on a flat floor at five different speeds and the test was repeated on the same day and after 3 months. The walk ratio did not vary in the tests. Intraclass correlation coefficients of the walk ratio between the tests were 0.6-0.8 except for walking at extreme speeds. These results suggest that the walk ratio is a reliable measure for evaluating pathological and aging walking patterns. Copyright 1998 Elsevier Science B.V. All rights reserved
Article
The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities. The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults. Ninety-six community-dwelling elderly people (61-89 years of age) with independent functioning performed 4 clinical tests. Data were collected on the Six-Minute Walk Test (6MW), Berg Balance Scale (BBS), and Timed Up & Go Test (TUG) and during comfortable- and fast-speed walking (CGS and FGS). Intraclass correlation coefficients (ICCs) were used to determine the test-retest reliability for the 6MW, TUG, CGS, and FGS measurements. Data were analyzed by gender and age (60-69, 70-79, and 80-89 years) cohorts, similar to previous studies. Means, standard deviations, and 95% confidence intervals for each measurement were calculated for each cohort. The 6MW, TUG, CGS, and FGS measurements showed high test-retest reliability (ICC [2,1]=.95-.97). Mean test scores showed a trend of age-related declines for the 6MW, BBS, TUG, CGS, and FGS for both male and female subjects. Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS. Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons.