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Problems of older persons using a wheeled walker



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
ISSN 1720-8319
Aging Clin Exp Res
DOI 10.1007/s40520-015-0410-8
Problems of older persons using a wheeled
Ulrich Lindemann, Michael Schwenk,
Jochen Klenk, Max Kessler, Michael
Weyrich, Franziska Kurz & Clemens
1 23
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Problems of older persons using a wheeled walker
Ulrich Lindemann
Michael Schwenk
Jochen Klenk
Max Kessler
Michael Weyrich
Franziska Kurz
Clemens Becker
Received: 2 March 2015 / Accepted: 3 July 2015
ÓSpringer International Publishing Switzerland 2015
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
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
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
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
Department of Geriatrics and Clinic for Geriatric
Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110,
70376 Stuttgart, Germany
University Stuttgart Research Initiative Human Factors in
Ageing, Technology and Environment, Stuttgart, Germany
Institute of Epidemiology, Ulm University, Helmholzstr. 22,
89081 Ulm, Germany
Institute for Automation and Software Engineering,
University of Stuttgart, Pfaffenwaldring 47, 70569 Stuttgart,
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
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
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
, 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
) 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
Author's personal copy
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.
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).
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?’
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
Author's personal copy
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.
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
Author's personal copy
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
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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... Consequently, therapist fatigue and staffing capacity limits what a patient is able to achieve in a session [13]. Assistive devices such as walkers are commonly provided to patients with mobility impairments [14]. These devices fall under the umbrella of 'assistive technology' , which describes products or systems that assist individuals with disabilities, restricted mobility or other impairments to perform functions that might otherwise be impossible or challenging [15]. ...
... These devices fall under the umbrella of 'assistive technology' , which describes products or systems that assist individuals with disabilities, restricted mobility or other impairments to perform functions that might otherwise be impossible or challenging [15]. Although assistive devices can improve rehabilitation of muscle and neural processing, they have limitations that prevent individuals from carrying out their ADLs as normal [14]. Reported challenges include opening of doors or getting on to public transport when using four-wheeled walkers, and issues carrying items, food and drink when using a walking stick [14,16,17]. ...
... Although assistive devices can improve rehabilitation of muscle and neural processing, they have limitations that prevent individuals from carrying out their ADLs as normal [14]. Reported challenges include opening of doors or getting on to public transport when using four-wheeled walkers, and issues carrying items, food and drink when using a walking stick [14,16,17]. ...
Full-text available
Background Soft, wearable, powered exoskeletons are novel devices that may assist rehabilitation, allowing users to walk further or carry out activities of daily living. However, soft robotic exoskeletons, and the more commonly used rigid exoskeletons, are not widely adopted clinically. The available evidence highlights a disconnect between the needs of exoskeleton users and the engineers designing devices. This review aimed to explore the literature on physiotherapist and patient perspectives of the longer-standing, and therefore greater evidenced, rigid exoskeleton limitations. It then offered potential solutions to these limitations, including soft robotics, from an engineering standpoint. Methods A state-of-the-art review was carried out which included both qualitative and quantitative research papers regarding patient and/or physiotherapist perspectives of rigid exoskeletons. Papers were themed and themes formed the review’s framework. Results Six main themes regarding the limitations of soft exoskeletons were important to physiotherapists and patients: safety; a one-size-fits approach; ease of device use; weight and placement of device; cost of device; and, specific to patients only, appearance of the device. Potential soft-robotics solutions to address these limitations were offered, including compliant actuators, sensors, suit attachments fitting to user’s body, and the use of control algorithms. Conclusions It is evident that current exoskeletons are not meeting the needs of their users. Solutions to the limitations offered may inform device development. However, the solutions are not infallible and thus further research and development is required.
... Among these, accessibility issues are commonly reported in both public and private spaces, and are often related to the presence of level differences restricting access for wheelchair and mobility scooter users (Gitelman et al., 2016;Thoreau, 2015;Rossen et al., 2012). Unsuitable housing environments, specifically relating to walker users, have also been reported as problematic and have been implicated in increasing the risk of falls (Lindemann et al., 2016;Fritz et al., 2013;Callisaya et al., 2012). ...
... This study found that turning a walker in a small room was avoided by many participants and in one incidence even caused a fall. The rear wheels of typical wheeled walkers are non-rotatable (Lindemann et al., 2016), so spinning directly on the spot is not possible without lifting the rear wheels, which is hazardous for those with limited strength or balance. Therefore, walking in a wider circle is necessary to turn around safely. ...
... The study results aligned with previous research (Lindemann et al., 2016) which revealed the difficulty of walker users when passing through a door and the difficulty in moving backwards to open a hinged door inwards This problem has also been linked with an increase in falls (Fritz et al., 2013;Callisaya et al., 2012). A 600 mm-wide side panel is found to be necessary for opening a hinged door safely, which is consistent with the requirement in the ISO standards, which also requires a wall of at least 600 mm (ISO, 2021). ...
Applied Ergonomics Volume 97, November 2021, 103539 Housing design that improves the independence and safety for older adults using a walker Author links open overlay panelYukikoKuboshima1JacquelineMcIntoshSchool of Architecture, Victoria University of Wellington, New Zealand Received 8 April 2021, Revised 12 July 2021, Accepted 21 July 2021, Available online 7 August 2021. Show less Outline Share Cite rights and content Highlights •A detailed ethnographic survey reveals the difficulties of 16 older adults. Abstract Globally, the walker is one of the most common assistive technologies used by older adults with mobility impairments, which is also the case in New Zealand. However, there is a scarcity of knowledge regarding their specific requirements in housing design. Adopting an ethnographic approach, the perceptions and spatial use of 16 older adults who used a walker were investigated as part of a larger study on quality of life and housing design. Five emergent themes for walker user perception and spatial use were identified, from which design considerations were distilled and then categorised into 10 design elements. The study highlights differences between the requirements for accommodating walkers and those for accommodating wheelchair users. It provides new insights into improved housing design for older adults, which have the potential to be incorporated into existing frameworks for accessible design and universal design thereby improving the independence and safety of older adults.
... 4 Commonly, those with mobility impairments use walking aids for assistance and to reduce their risk of falls. [5][6][7] Those with lower-limb amputation commonly receive a prosthesis, as part of their rehabilitation process. 8 These devices fall under the umbrella of 'assistive technology', which describes products or systems that assist those with disabilities, restricted mobility or other impairments to perform functions that might otherwise be challenging or impossible. ...
... 9 Mobility assistive devices can in themselves cause challenges; for instance, users of fourwheel walkers have reported issues in opening doors and getting their walker onto public transport. 5 Walking sticks limit a person to one free arm, while users of walkers without baskets have issues carrying items, food and drinks. 10 In fact, the use of assistive devices can result in unsafe walking behaviours. ...
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Introduction Current assistive devices are inadequate in addressing the needs of some people living with impaired mobility. This study explored the experiences of living with impaired mobility in relation to how wearable assistive adaptive and rehabilitative technologies may improve their quality of life. Methods A cross-case study approach was adopted; the case being defined as the experience of impaired mobility. Semi-structured interviews were utilised. The sample ( n = 8) was purposefully selected to have impaired mobility due to stroke, age-related frailty, or lower limb amputation. From the interview transcripts, in-depth case illustrations were written to provide personal stories and thematic analysis was carried out to provide a cross-case analysis. Results There were two overarching themes: lifestyle changes; and wishes and desires for assistive devices. There were shared experiences across participant groups, such as falls and fear of falling. All participants identified a wish for increased speed of walking. However, the reasons for their difficulties differed depending on personal factors and their condition. Participants wanted devices to be adjustable to their perceived ability on a day-to-day basis. Conclusions Although common concerns and impacts of living with impaired mobility were apparent, individuals have unique requirements that should inform the design of assistive technology devices.
... Although relevant results are presented in terms of improved performance during the tests, there is no evidence of studies where the difficulty of the tests is increased with the aim of both physically and cognitively stimulating the user (i.e., more extended gait tasks and turns before the subject sits down). On the other hand, other studies have also been presented where the effect of the walker on the gait pattern of the subjects in scenarios that emulate daily activities (Wang et al., 2014;Lindemann et al., 2016Lindemann et al., , 2017Costamagna et al., 2019;Mundt et al., 2019). ...
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The constant growth of the population with mobility impairments, such as older adults and people suffering from neurological pathologies like Parkinson's disease (PD), has encouraged the development of multiple devices for gait assistance. Robotic walkers have emerged, improving physical stability and balance and providing cognitive aid in rehabilitation scenarios. Different studies evaluated human gait behavior with passive and active walkers to understand such rehabilitation processes. However, there is no evidence in the literature of studies with robotic walkers in daily living scenarios with older adults with Parkinson's disease. This study presents the assessment of the AGoRA Smart Walker using Ramps Tests and Timed Up and Go Test (TUGT). Ten older adults participated in the study, four had PD, and the remaining six had underlying conditions and fractures. Each of them underwent a physical assessment (i.e., Senior Fitness, hip, and knee strength tests) and then interacted with the AGoRA SW. Kinematic and physical interaction data were collected through the AGoRA walker's sensory interface. It was found that for lower limb strength tests, older adults with PD had increases of at least 15% in all parameters assessed. For the Sit to Stand Test, the Parkinson's group evidenced an increase of 23%, while for the Chair Sit and Reach Test (CSRT), this same group was only 0.04 m away from reaching the target. For the Ramp Up Test (RUT), the subjects had to make a greater effort, and significant differences ( p-value = 0.04) were evidenced in the force they applied to the device. For the Ramp Down Test (RDT), the Parkinson's group exhibited a decrease in torque, and there were statistically significant differences ( p-value = 0.01) due to the increase in the complexity of the task. In the Timed Up and Go Test (TUGT), the subjects presented significant differences in torque ( p-value of 0.05) but not in force ( p-value of 0.22) due to the effect of the admittance controller implemented in the study. Finally, the results suggested that the walker, represents a valuable tool for assisting people with gait motor deficits in tasks that demanded more physical effort adapting its behavior to the specific needs of each user.
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Purpose Despite the increase of users of Mobility Assistive Devices (MobAD), there has been a lack of accessibility in urban environments in many parts of the world. We present a systematic review of how the inaccessible design of public spaces affects quality-of-life – including aspects of health and safety, independence, and social participation – of MobAD users. Materials and methods We conducted a literature search in three databases (i.e., Scopus, Web of Science, and PubMed) and initially discovered 3980 publications. We analysed 48 peer-reviewed journal articles published in English from 2005 to 2021 and assessed their quality of evidence via the Mixed Methods Appraisal Tool. Results Findings indicated a substantial number of inaccessible elements for MobAD users in public spaces. Pathway characteristics, boarding ramps, entrance features, confined spaces, and service surfaces were deemed to be the least accessible elements. These barriers had multifaceted effects on MobAD users’ quality of life with aspects of physical health, mobility, and use of public transport being most affected. Conclusions Notwithstanding that the reviewed studies mostly ocused on wheelchair users residing in high-income countries, this review outlines the critical role of the design of the built environment as a factor of disablement for MobAD users. We conclude by highlighting a few recommendations for future research and practice, especially inclusive approaches and adaptive techniques to assist MobAD users with performing tasks in public spaces independently. • Implications for Rehabilitation • Users of Mobility Assistive Devices experience a lack of accessibility provisions in public open spaces and buildings internationally. • Physical barriers in public spaces substantially diminish the health and safety, autonomy, and social participation of users of Mobility Assistive Devices. • There is a definite need for the adoption of inclusive strategies and adaptive techniques in placemaking processes so that users of Mobility Assistive Devices can have equitable access to public spaces.
Purpose: The study aims to identify risk factors for falling among acutely ill older patients, hospitalized in acute geriatric ward. Methods: A retrospective study of 260 cases of patients who had fallen and 439 controls was conducted in a geriatric ward. We retrieved from the electronic hospital records data including patient demographics, medical diagnoses, and laboratory results, and drugs taken prior to the fall were reviewed. In addition, data on functional and cognitive status were recorded. Admission Morse Falls Scale for every patient was also retrieved. Results: The following on-admission diagnoses were associated with a higher incidence of falls during hospitalization: hypertension (84% vs. 38%), congestive heart failure (CHF), 74% vs 16%, dementia (36% vs. 5%), and delirium (36% vs 5%). A higher percentage of fallers compared to controls consumed beta blockers (69% vs. 53%), benzodiazepines (46% vs. 32%), antidepressants (33% vs. 23%), oral diabetes drugs (20% vs. 11%) and opiates (8% vs. 4%). On-admission Morse Falls Scale score was found to be higher in the patients who fell (59 vs.53). The strongest predictors of falling during hospitalization were CHF, hypertension, dementia, delirium, assisted mobility and dependence. Conclusion: A systematic screening of risk factors for falls and identification of them might contribute to reducing the risk associated with falls during hospitalization.
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When promoting physical activity (PA) to older persons, perceived wording is of importance and mostly not congruent with the scientific approach. The differentiation within physical activity subcategories is often unnoticed by other health professionals as well as by older persons. Especially, the subcategory of exercise as a planned, structured, repetitive program is often used interchangeably with PA. This short communication addresses the different perceptions in wording between health care professionals, sport scientists, and lay older persons with the goal to enhance the awareness of wording for professionals, which is a prerequisite for designing appropriate messages.
Fault diagnosis is a key safety component in robotic assistive technologies. Although conventional model-based methods for sensor fault diagnosis in mobile robots have been well established, they face challenges due to model parameter changes and uncertainties. On the other hand, data-driven approaches becomes more appealing in order to take advantage from available historical data in the era of Big Data. To provide a new generic unsupervised solution to the fault detection and recovery, we explicitly include kinematic relations and temporal finite differences from measured sensor signals into training a multi-task deep neural network. To evaluate the proposed fault diagnosis and recovery framework, experiments have been conducted on a robotic rollator platform. Experiments under several conditions confirm that the proposed approach, which leverages machine learning-enhanced algorithms, exhibits reliable performance. Outperforming other baselines and state-of-the-art diagnosis algorithms, the framework presents a promising solution to sensor fault recovery challenges in assitive devices.
Mobilität ist ein wesentlicher Faktor im Selbstständigkeitserhalt und für das „gesunde“ Altern. Mit zunehmendem Alter steigt das Risiko einer Mobilitätseinschränkung. Auch Stürze stellen für den älteren Menschen ein einschneidendes Erlebnis dar und können nicht nur physische Konsequenzen wie Verletzungen haben, sondern auch psychische Konsequenzen wie Sturzangst, die wiederum negative Verhaltensanpassungen bewirken, z. B. sich weniger zu bewegen.
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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.
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.
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.
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.
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
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.