Article

Satisfaction with rollators among community-living users: A follow-up study

Taylor & Francis
Disability and Rehabilitation
Authors:
  • The National Board of Social Services, Denmark
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Abstract

Rollators are used in order to make mobility possible for people with restricted walking ability. The use of rollators is increasing, but little is known about outcomes. The aim of this study was to investigate users' satisfaction with rollators. A follow-up study was carried out in seven Danish municipalities. One month after they got their device, 89 users of rollators were interviewed by means of the QUEST 1.0. Three months after the first interview a second interview took place and data from the 64 users available for follow-up were analysed. The users were satisfied with their rollators, and the frequency of use was high. However, many of the users were frail, and some of them were not fully satisfied in all respects. Women especially, users living alone and first time users were likely to be dissatisfied. The main problem identified was handling the rollator, and for several users the physical environment caused accessibility problems. Rollators are valuable for the users and a relevant societal intervention. However, a better match between person and technology, enhanced user training and follow-up can improve the outcome of the intervention. Furthermore, better rollator design is called for, and buses and the outdoor environment need to be made more accessible.

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... However, traditional mobility aids have their disadvantages. For example, the rollator, commonly used by older adults, has been criticized for being heavy and bulky, making it difficult to handle, park, and transport the device [5,34]. Additionally, most walking aids such as canes and walkers do not provide sufficient support during sit-to-stand transfers, which are an integral part of daily life [29]. ...
... Besides the technical developments of exoskeletons, it is important to focus on the perspective of the user [9]. User acceptance and usability are critical factors in the successful adoption of any assistive technology, therefore it is important to involve end-users and other stakeholders in the development process [5,7,9,24,34,38]. To this end, we will explore the views of older adults and clinicians on exoskeleton technology to assist with daily living. ...
... It is important for developers of mobility aids and clinicians who prescribe these devices to be sensitive to the stigmas that people might associate with the use of assistive devices [9]. Older adults and their relatives will most likely need time to accept the need for a (new) mobility aid and to get acquainted with the device [5]. A study on the perception of walkers among older adults showed that concerns about the need for a walker often subsided with time [24]. ...
Article
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Mobility impairments can prevent older adults from performing their daily activities, which highly impacts quality of life. Powered exoskeletons, which are wearable robotic devices, can assist older adults by providing additional support to compensate for age-related decline in muscle strength. To date, little is known about the opinions and needs of older adults regarding exoskeletons, as current research primarily focuses on the technical development of exoskeleton devices and on groups with more severe mobility impairments such as people with spinal cord injuries. Therefore, the aim of this article is to inform the design of exoskeletons for older adults from a person-centered perspective. Interviews were conducted with seven older adults and six clinicians. Results indicated that exoskeletons can be a valuable addition to existing mobility devices to support older adults during walking and other actions necessary to perform their daily activities. Although reactions towards the concept of exoskeleton technology were positive, older adults did not currently perceive the need for an exoskeleton device. Exoskeletons for older adults should be easy to use; preferably, users should be able to put the device on and take it off independently. Moreover, the appearance of the exoskeleton should be as inconspicuous as possible, as most older adults do not like to advertise their need for assistive devices. At this point in time, the willingness to use exoskeleton technology will depend on personal needs and preferences.
... In the United States, approximately 4.3 million people over 65 use at least one walking aid [4], The associate editor coordinating the review of this manuscript and approving it for publication was Dian Tjondronegoro. with a view to safely increasing mobility [5], and the majority of walking aid users reported using theirs on a daily basis [5], [6]. However, despite their widespread use, studies of mobility in the older people have often ignored the role played by walking aids [7], [8]. ...
... In the United States, approximately 4.3 million people over 65 use at least one walking aid [4], The associate editor coordinating the review of this manuscript and approving it for publication was Dian Tjondronegoro. with a view to safely increasing mobility [5], and the majority of walking aid users reported using theirs on a daily basis [5], [6]. However, despite their widespread use, studies of mobility in the older people have often ignored the role played by walking aids [7], [8]. ...
... One commonly used and apparently well-accepted walking aid is the rollator [5], [6]. Brandt et al. reported [5] that rollator users in Denmark expressed 94% overall satisfaction with their device, 4 months after its prescription. ...
Article
Full-text available
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.
... Similar results have been reported from other studies (Hastings Kraskowsky & Finlayson, 2001;Roelands et al. 2002). Studies with a focus on a special kind of device, such as mobility devices, have also shown many different experiences of advantages (Bateni & Maki, 2005;Brandt, Iwarsson & Ståhl, 2003). ...
... Opinions about the symbolic value of assistive technology diverge, i.e. one loses ability, one gains ability to participate in everyday life. The use of a certain device might either generate respect or lead to an inadequate reception in the environment (Brandt et al. 2003;Copolillo, 2001;McMillen & Söderberg, 2002;Pape et al. 2002). As an object in the environment, assistive technology also has personal and social values in everyday life and can be described both at the individual, social and cultural level (Csikszentmihalyi & Rochberg-Halton, 1981;Hocking, 1994;Kielhofner, 2002). ...
... The many advantages of using assistive devices to facilitate or enable participation in everyday life, particularly with reference to personal safety and security, have been brought out (study II) and confirm earlier studies (Bateni & Maki, 2005;Brandt et al. 2003;Sonn & Grimby, 1994). ...
... Wheels have been added, so that we can now talk about a 3-or 4-wheeled walker or rolling walker. The terminology used in the literature has not been standardized [14]. Referring to the ISO 9999 classification of technical aids for people with disabilities [15], we can say that the denotation ''rollator'' is the most popular one in Europe. ...
... The rollator is a relatively cheap assistive device, easy to use and for this reason favored by users [14,16], and employed frequently in neurorehabilitation [11,[17][18][19][20]. It consists of a metal base frame on four wheels (inflated or of hard rubber), two highadjustable bar ends with hand brakes, and usually a seat and a basket. ...
... Astonishing to mention is that rollator loading operates in opposition to the rollator's proper positive characteristics, e.g. its light weight and simple maneuverability. Brand et al. [14] reported on the satisfaction with rollators among users living in the community and postulated that the high-dead load was even the predominant point of criticism in the geriatric cohort. ...
Article
Abstract Purpose: Rollator loading is an application used clinically sometimes to improve functional integrity and security of the patients' gait. As empirical evidence supporting this intervention is equivocal, the purpose of this study was to examine the effects of rollator loading on several gait parameters and fall risk. Methods: An explicatory experiment with a follow-up cohort study of falls was conducted. In the experimental part of the study, participants (n = 25) were evaluated three times by means of different gait and fall risk assessments, whereby each trial was carried out with different rollator loading (0, 4.5 and 9 kg, respectively). Participants were blinded towards the applied load. In addition, the odds ratio of falls with respect to rollator loading in all-day rehabilitation life was determined. Results: No changes in spatio-temporal gait parameters and fall risk in relation to a particular load could be identified by clinical measures in the tested sample. A separate sub-group analysis (Parkinson's disease, hemiparesis and ataxia) showed only little impact of the load in each case. Rollator loading had no impact on the odds ratio of inpatient fall risk. Conclusion: On the basis of our findings, weighting of rollators can neither be discouraged nor recommended. Implications for Rehabilitation Unless more research is has been conducted on this topic, rollator loading can neither be recommended nor discouraged in individuals suffering from neurologic diseases. There is more research needed to examine the impact on ambulation in distinct conditions such as severe ataxia and fear of falling.
... Some of the most commonly mentioned assistive device limitations or dissatisfaction reasons, as mentioned by users and health scientists, are: (i) handling the rollator gait assistive device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006), (ii) the weight of the device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006;Hill, Goldstein, Gartner & Brooks, 2008), (iii) the brake-use of rollator devices (Thomas et al., 2010), (iv) users are prone to falling because of the dependence on memory to activate the rollator's parking mechanism, (v) the inability of the current rollator to effectively park when the braking mechanism is engaged (Siu et al., 2008), (vi) social stigmatizing (association with aging and physical decline) (Hallén, Orrenius & Rose, 2006) (Hill, Goldstein, Gartner & Brooks, 2008;Thomas et al., 2010;Resnik, Allen, Isenstadt, Wasserman & Iezzoni, 2009), and (vii) upper-extremity pathologies because of the extended use of walking aids (i.e. tendonitis, osteoarthritis, and carpal tunnel syndrome) . ...
... Some of the most commonly mentioned assistive device limitations or dissatisfaction reasons, as mentioned by users and health scientists, are: (i) handling the rollator gait assistive device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006), (ii) the weight of the device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006;Hill, Goldstein, Gartner & Brooks, 2008), (iii) the brake-use of rollator devices (Thomas et al., 2010), (iv) users are prone to falling because of the dependence on memory to activate the rollator's parking mechanism, (v) the inability of the current rollator to effectively park when the braking mechanism is engaged (Siu et al., 2008), (vi) social stigmatizing (association with aging and physical decline) (Hallén, Orrenius & Rose, 2006) (Hill, Goldstein, Gartner & Brooks, 2008;Thomas et al., 2010;Resnik, Allen, Isenstadt, Wasserman & Iezzoni, 2009), and (vii) upper-extremity pathologies because of the extended use of walking aids (i.e. tendonitis, osteoarthritis, and carpal tunnel syndrome) . ...
Chapter
The ageing of the population is one of the major societal and financial problems. The prevalence of disability increases dramatically by age. The loss of mobility can be devastating to the elderly. Mobility aids are a one-way street to maintain independent mobility. The performance of daily activities is restrained by a series of factors related to the assistive device limitations, or the ones emerged from environmental causes. A literature review reveals minimal tools for assessing mobility assistive devices able to capture users' satisfaction. The chapter presents an assessment methodology in order to investigate assistive mobility devices' limitations, dissatisfaction reasons, and identifies the most appropriate tools to study such limitations and conclude in valid outcomes. One of the valuable characteristics of the study presented in its generalizability since it is not disease oriented. A summary of the results from both the literature review and the real case study on a mixed group of end users are presented in the chapter.
... Some of the most commonly mentioned assistive device limitations or dissatisfaction reasons, as mentioned by users and health scientists, are: (i) handling the rollator gait assistive device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006), (ii) the weight of the device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006;Hill, Goldstein, Gartner & Brooks, 2008), (iii) the brake-use of rollator devices (Thomas et al., 2010), (iv) users are prone to falling because of the dependence on memory to activate the rollator's parking mechanism, (v) the inability of the current rollator to effectively park when the braking mechanism is engaged (Siu et al., 2008), (vi) social stigmatizing (association with aging and physical decline) (Hallén, Orrenius & Rose, 2006) (Hill, Goldstein, Gartner & Brooks, 2008;Thomas et al., 2010;Resnik, Allen, Isenstadt, Wasserman & Iezzoni, 2009), and (vii) upper-extremity pathologies because of the extended use of walking aids (i.e. tendonitis, osteoarthritis, and carpal tunnel syndrome) . ...
... Some of the most commonly mentioned assistive device limitations or dissatisfaction reasons, as mentioned by users and health scientists, are: (i) handling the rollator gait assistive device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006), (ii) the weight of the device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006;Hill, Goldstein, Gartner & Brooks, 2008), (iii) the brake-use of rollator devices (Thomas et al., 2010), (iv) users are prone to falling because of the dependence on memory to activate the rollator's parking mechanism, (v) the inability of the current rollator to effectively park when the braking mechanism is engaged (Siu et al., 2008), (vi) social stigmatizing (association with aging and physical decline) (Hallén, Orrenius & Rose, 2006) (Hill, Goldstein, Gartner & Brooks, 2008;Thomas et al., 2010;Resnik, Allen, Isenstadt, Wasserman & Iezzoni, 2009), and (vii) upper-extremity pathologies because of the extended use of walking aids (i.e. tendonitis, osteoarthritis, and carpal tunnel syndrome) . ...
Chapter
The ageing of the population is one of the major societal and financial problems. The prevalence of disability increases dramatically by age. The loss of mobility can be devastating to the elderly. Mobility aids are a one-way street to maintain independent mobility. The performance of daily activities is restrained by a series of factors related to the assistive device limitations, or the ones emerged from environmental causes. A literature review reveals minimal tools for assessing mobility assistive devices able to capture users' satisfaction. The chapter presents an assessment methodology in order to investigate assistive mobility devices' limitations, dissatisfaction reasons, and identifies the most appropriate tools to study such limitations and conclude in valid outcomes. One of the valuable characteristics of the study presented in its generalizability since it is not disease oriented. A summary of the results from both the literature review and the real case study on a mixed group of end users are presented in the chapter.
... The interpretation of our findings that the use of a WW can be objectively measured by instrumented gait parameters is limited by several considerations: For the FTU group familiarization aspects might be confounding factors for the change of gait parameters. It has been reported that first time WW usage can lead to dissatisfaction and requires to get used to the WW [75]. Furthermore, the use of a WW can be stigmatizing and thereby negatively affect the use of a WW. ...
... Furthermore, the use of a WW can be stigmatizing and thereby negatively affect the use of a WW. In addition, the importance of an introduction, training in basic functions and handling of the WW prior to first time use has an impact on the applicability of a WW [74,75]. Even though we included a short time of familiarization with the WW for FTU, we cannot exclude that low familiarization affects the outcome gait parameters. ...
Article
Full-text available
Background In an increasing aging society, reduced mobility is one of the most important factors limiting activities of daily living and overall quality of life. The ability to walk independently contributes to the mobility, but is increasingly restricted by numerous diseases that impair gait and balance. The aim of this cross-sectional observation study was to examine whether spatio-temporal gait parameters derived from mobile instrumented gait analysis can be used to measure the gait stabilizing effects of a wheeled walker (WW) and whether these gait parameters may serve as surrogate marker in hospitalized patients with multifactorial gait and balance impairment. Methods One hundred six patients (ages 68–95) wearing inertial sensor equipped shoes passed an instrumented walkway with and without gait support from a WW. The walkway assessed the risk of falling associated gait parameters velocity, swing time, stride length, stride time- and double support time variability. Inertial sensor-equipped shoes measured heel strike and toe off angles, and foot clearance. Results The use of a WW improved the risk of spatio-temporal parameters velocity, swing time, stride length and the sagittal plane associated parameters heel strike and toe off angles in all patients. First-time users (FTUs) showed similar gait parameter improvement patterns as frequent WW users (FUs). However, FUs with higher levels of gait impairment improved more in velocity, stride length and toe off angle compared to the FTUs. Conclusion The impact of a WW can be quantified objectively by instrumented gait assessment. Thus, objective gait parameters may serve as surrogate markers for the use of walking aids in patients with gait and balance impairments.
... Der Rollator ist ein einfach zu bedienendes, kostengüns tiges und daher bei Benutzern beliebtes Hilfsmittel [11,42], welches typischerweise aus einem Metallgestell auf drei oder vier Rädern (luftgefüllt oder Hartgummi), zwei höhenverstellbaren Griffen mit Brem sen, meist einem Sitz und einem Korb besteht. Das Eigengewicht des Rollators beträgt zwischen 7 und 12 kg [48]. ...
... Dazu zählen seine Leichtigkeit und die einfache Lenkbarkeit. In einer dänischen Studie war sogar das zu hohe Eigen gewicht der Hauptkritikpunkt der geriatrischen Kohorte am Rollator [11]. ...
... In general, lack of environmentalal fit can hinder accessibility and participation [3,6] in WW users. A deterioration of walking performance when using a WW can also be attributed to certain diseases, e. g. ...
... A deterioration of walking performance when using a WW can also be attributed to certain diseases, e. g. Parkinson's disease [3,4]. Furthermore, at least in novice WW users a motor dual-task paradigm can be applied, which has been shown to decrease walking performance in older persons [11]. ...
Article
Full-text available
Background: Wheeled walkers are recommended to improve walking performance in older persons and to encourage and assist participation in daily life. Nevertheless, using a wheeled walker can cause serious problems in the natural environment. This study aimed to compare uphill and downhill walking with walking level in geriatric patients using a wheeled walker. Furthermore, we investigated the effect of using a wheeled walker with respect to dual tasking when walking level. Methods: A total of 20 geriatric patients (median age 84.5 years) walked 10 m at their habitual pace along a level surface, uphill and downhill, with and without a standard wheeled walker. Gait speed, stride length and cadence were assessed by wearable sensors and the walk ratio was calculated. Results: When using a wheeled walker while walking level the walk ratio improved (0.58 m/[steps/min] versus 0.57 m/[steps/min], p = 0.023) but gait speed decreased (1.07 m/s versus 1.12 m/s, p = 0.020) when compared to not using a wheeled walker. With respect to the walk ratio, uphill and downhill walking with a wheeled walker decreased walking performance when compared to level walking (0.54 m/[steps/min] versus 0.58 m/[steps/min], p = 0.023 and 0.55 m/[steps/min] versus 0.58 m/[steps/min], p = 0.001, respectively). At the same time, gait speed decreased (0.079 m/s versus 1.07 m/s, p < 0.0001) or was unaffected. Conclusion: The use of a wheeled walker improved the quality of level walking but the performance of uphill and downhill walking was worse compared to walking level when using a wheeled walker.
... A small number of studies have reported on user views on rollators. Brandt et al. [7] carried out a longitudinal study using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST version 1) to understand the satisfaction with rollators among community-dwelling users (mean age of 76) in Denmark. The overall satisfaction with rollators was above 90%, particularly with the effectiveness, durability and safety of rollators. ...
... A study by Lindemann et al. [8] found that rollator users reported walking downhill, uphill, over uneven surfaces outdoors, and obstacle crossing to be major concerns with regard to safety . Rollator users in Denmark [7] and Japan [9] were found to be less satisfied with the professional and follow-up services, including the provision of training by the physiotherapists, repairs, and visits. This left them without enough knowledge of basic instructions, adjustments to and repairs of their rollator. ...
Article
The use of walking aids is prevalent among older people and people with mobility impairment. Rollators are designed to support outdoor mobility and require the user to negotiate curbs and slopes in the urban environment. Despite the prevalence of rollators, analysis of their use outside of controlled environments has received relatively little attention. This paper reports on an initial study to characterise rollator movement. An inertial measurement unit (IMU) was used to measure the motion of the rollator and analytical approaches were developed to extract features characterising the rollator movement, properties of the surface, and push events. The analytics were tested in two situations, firstly a healthy participant used a rollator in a laboratory using a motion capture system to obtain ground truth. Secondly the IMU was used to measure the movement of a rollator being used by a user with multiple sclerosis (MS) on a flat surface, cross-slope, up and down slopes, and up and down a step. The results showed that surface inclination and distance travelled measured by the IMU have close approximation to the results from ground truth, therefore demonstrating the potential for IMU-derived metrics to characterise rollator movement and user’s pushing style in the outdoor environment.
... Besides showing that MDs are one of the most commonly used devices in very old age, [13,14] these studies explored outcomes for using MDs [15,16] as well as changes in the use of MDs over time during the ageing process. [17][18][19][20] Some studies highlight individuals' experiences with the MD prescription process [8,21] and users' attitudes towards the devices. [8,20,22] These findings suggest that the use of MDs can be highly variable depending on a person's abilities, the activities performed, and the environmental factors. ...
... [19] Moreover, MDs are often used to compensate for functional limitations or for safety reasons, and their use increases with advancing age. [18,20] The findings from studies on the use of MDs are mainly based on samples from Western European countries and North America, and there is no detailed information regarding older people's perceptions of the use and need for MDs in countries such as Latvia. One study, based on data from five European countries, including Latvia, [13] showed that MDs were the second largest category of ADs used by the participants. ...
Article
Full-text available
To explore the experiences over time of using mobility devices (MDs) among very old women in the context of everyday life in Latvia. This study utilized a multiple case-study design that employed an explanatory mixed-methods approach. A combination of quantitative survey data on home and health and qualitative interview data for each participant were used to create three narratives to describe the experiences of MD use in everyday life over time, followed by a cross-case analysis. The three cases illustrate that very old women accept and use MDs due to walking difficulties and related needs. Over time, functional decline combined with physical environmental barriers and changes in their social networks limited the supportive role that available MDs could offer these women. The findings contribute to the understanding of the complexity of MD use in everyday life among very old women in Latvia and the need for different kinds of MDs. These findings illustrate the importance of considering the interaction between people's everyday life situation and their physical environment for their optimal use of MDs. This is important information for policy-makers who can optimize the services for old people in Latvia and support the need for occupational therapists' professional competence for the planning and development of MD provision.
... Although prevalence estimates have not been well-reported, the available numbers indicate a high number of 4-wheeled rollator users worldwide. In Sweden, a reported 250 000 people use 4wheeled rollators (4% of total population) [17] and in the province of Ontario (Canada), an estimated 50 000 (0.4% total population) new 4-wheeled rollators were publicly subsidized between the years 2001-2006 [100]. Since prescriptions are not required to obtain these devices, private purchases are common and are not accounted for in these user estimates and considering the projected growing elderly demographic, actual user numbers are likely to rise. ...
... In particular, turning and navigating with a rollator was a common characteristic of the circumstances for potentially destabilizing events from all three cases. This finding provides empirical evidence to support the perceived difficulty of manoeuvrability when using rollators [17]. Manoeuvrability issues were likely due to the increased physical footprint associated with using a rollator, similar to the issues observed in adapting to the wider base of wheelchairs [68,54]. ...
... Another experience is related to mobility assistance, e.g., wheeled walkers. Often, participants are unaware and lacking information about the right usage of wheeled walkers and are not satisfied with the wheeled walkers (Brandt, Iwarsson, & Stahl, 2003;Lindemann et al., 2016). ...
Article
Full-text available
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.
... The use of assistive walking devices facilitates movement and diminishes the risk of falling; when incorporated into daily life, walking aids have been found to enable several domains of activity and participation (Mansouri & Goher, 2016). Here, an effective rollator design and a more accessible outdoor environment are considered important for optimal use (Brandt et al., 2003). ...
Article
Full-text available
Background Improved life expectancy combined with suboptimal physical activity (PA) represents an increasingly salient public health challenge among the elderly. PA in late life is associated with fewer health problems in old age. Assistive information and communication technology might improve PA and alleviate health problems among the elderly. Research Aim The aim of this pilot study was to quantitatively measure the motivational aspects related to rollator use and, by using qualitative interviews, outline how a Smart Rollator solution would motivate older adults to increase their PA in their everyday lives. Methods A total of 19 subjects between the ages of 63 and 91 years participated in the study. Half of the participants started in a setting in which the application did not provide feedback to the user, and the other half received feedback. A transition occurred (ordinary rollator to Smart Rollator and vice versa) after two months of usage. Motivational aspects were measured before the use of rollator and after four months. Semi-structured qualitative interviews were conducted with 10 participants to acquire information about their experiences. Results On the motivation questionnaire, self-perceived mental vitality showed a significant decrease at follow-up, but the total score did not change. Three different types of Smart Rollator users were identified based on the interview data: enthusiastic, practical, and disappointed users. The user types differed from each other, especially regarding user experiences concerning the smart features and intelligent features of the rollator. Conclusions We conclude that the individual variations in terms of benefiting from the use of the Smart Rollator were large and that some users reported clear advantages using the Smart Rollator. The Smart Rollator elicited emotional reactions and affection, as well as frustration if the user was not able to benefit from the Smart Rollator as expected. A larger sample size is warranted to thoroughly specify the relations between the use of a Smart Rollator, user experiences, and PA.
... The use of assistive walking devices facilitates movement and diminishes the risk of falling; when incorporated into daily life, walking aids have been found to enable several domains of activity and participation (Mansouri & Goher, 2016). Here, an effective rollator design and a more accessible outdoor environment are considered important for optimal use (Brandt et al., 2003). ...
Article
Full-text available
Background: Improved life expectancy combined with suboptimal physical activity (PA) represents an increasingly salient public health challenge among the elderly. PA in late life is associated with fewer health problems in old age. Assistive information and communication technology might improve PA and alleviate health problems among the elderly. Objective: This pilot study aimed to quantitatively measure the motivational aspects related to rollator use and, by using qualitative interviews, outline how a Smart Rollator solution would motivate older adults to increase their PA in their everyday lives. Method: A total of 19 subjects between the ages of 63 and 91 years participated in the study. Half of the participants started in a setting in which the application did not provide feedback to the user, and the other half received feedback. A transition occurred (ordinary rollator to Smart Rollator and vice versa) after two months of usage. Motivational aspects were measured before the use of the rollator and after four months. Semi-structured qualitative interviews were conducted with 10 participants to acquire information about their experiences. Results: On the motivation questionnaire, self-perceived mental vitality showed a significant decrease at follow-up, but the total score did not change. Three different types of Smart Rollator users were identified based on the interview data: enthusiastic, practical, and disappointed users. The user types differed from each other, especially regarding user experiences concerning the smart features and intelligent features of the rollator. Conclusion: We conclude that the individual variations in terms of benefiting from the use of the Smart Rollator were large and that some users reported clear advantages using the Smart Rollator. The Smart Rollator elicited emotional reactions and affection, as well as frustration if the user was not able to benefit from the Smart Rollator as expected. Larger sample size is warranted to thoroughly specify the relations between the use of a Smart Rollator, user experiences, and PA.
... Some of the most commonly mentioned assistive device limitations or dissatisfaction reasons, as mentioned by users and health scientists, are: (1) handling the rollator gait assistive device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006), (2) the weight of the device (Brandt, Iwarsson & Ståhl, 2003;Hallén, Orrenius & Rose, 2006;Hill, Goldstein, Gartner & Brooks, 2008), (3) the brake-use of rollator devices (Thomas et al., 2010), (4) users are prone to falling because of the dependence on memory to activate the rollator's parking mechanism, (5) the inability of the current rollator to effectively park when the braking mechanism is engaged (Siu et al., 2008), (6) social stigmatizing (association with aging and physical decline) (Hallén, Orrenius & Rose, 2006) (Hill, Goldstein, Gartner & Brooks, 2008;Thomas et al., 2010;Resnik, Allen, Isenstadt, Wasserman & Iezzoni, 2009), and (7) upper-extremity pathologies because of the extended use of walking aids (i.e. tendonitis, osteoarthritis, and carpal tunnel syndrome) . ...
Chapter
The use of gait assistive devices, although can provide precious help can also have limitations or adverse consequences. The performance of daily activities is partially restrained by a series of factors having to do with the assistive device limitations or the limitations emerged from environmental causes. Valid and reliable assessment tools to classify and clarify their limitations or users' satisfaction do not exist. An extended literature search was performed for some of the most commonly mentioned assistive device limitations or dissatisfaction reasons and identified the most appropriate tools to be able to study such limitations and conclude in valid outcomes. A study was conducted in a rehabilitation hospital using the IPA, EQ5D and SF-12 tools. The size of the sample combined with the uncertainty related to the satisfaction of normal distribution prerequisite, led to use several statistical analysis tools and methodologies. A summary of the results from both the literature review and the real case study on a mixed group of mobility aid users are presented in the paper.
... 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.
... Som nemnt tidlegare så skal effekt av tiltak helst målast gjennom forskingsdesign så høgt oppe i det medisinske dokumentasjonshierarkiet som mogleg (Helse-og omsorgsdepartementet, 1997). For å imøtekomme dette, er det utført studiar for å måle effekten av innføringa av hjelpemiddel, som mellom anna måler bruksfrekvens av hjelpemiddelet eller tek utgangspunkt i strukturerte spørjeskjema eller kartleggingsinstrument (sjå til dømes Mortenson et al., 2013;Brandt et al., 2003;Mann et al., 1999;Phillips og Zhao, 1993). Slik effektforsking som ser på om hjelpemiddelet faktisk er kausalt ansvarleg for observerbare endringar, har to implisitte føresetnadar som er viktige å løfte fram. ...
... Satisfaction surveys with rollators indicate that the fit between the user and the technology needs to be improved by tailoring the functionalities and the structure of the walker to individual care status [18], [19]. ...
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.
... Rollators are of particular interest because their general use has been shown to be ineffective in terms of preventing serious fall-related injuries [11]. Interestingly, and of direct relevance to this work, users of rollators have complained about lack of training [12], with as many as 81% having received no instructions or training at all regarding the use of their device [13]. ...
Article
Full-text available
Walking aids are widely used by older adults, however, alarmingly, their use has been linked to increased falls-risk, yet clinicians have no objective way of assessing user stability. This work aims to demonstrate the application of a novel methodology to investigate how the type of walking task, the amount of body weight supported by the device (i.e., device loading), and task performance strategy affect stability of rollator users. In this context, ten users performed six walking tasks with an instrumented rollator. The combined stability margin “SM” was calculated, which considers user and rollator as a combined system. A Friedman Test was used to investigate the effects of task on SM and a least-squares regression model was applied to investigate the relationship between device loading and SM. In addition, the effects of task performance strategy on SM were explored. As a result, it was found that: the minimum SM for straight line walking was higher than for more complex tasks (p<0.05); an increase in device loading was associated with an increase in SM (p<0.05); stepping up a kerb with at least 1 rollator wheel in ground contact at all times resulted in higher SM than lifting all four wheels simultaneously. Hence, we conclude that training should not be limited to straight line walking but should include various everyday tasks. Within person, SM informs on which tasks need practicing, and which strategy facilitates stability, thereby enabling person-specific guidance/training. The relevance of this work lies in an increase in walking aid users, and the costs arising from fall-related injuries.
... However, traditional mobility aids have their disadvantages. For example, the four-wheeled walker, commonly used by older adults, has been criticized for being heavy and bulky making it difficult to handle and transport the device [2]. Additionally, most walking aids such as canes and walkers do not provide sufficient support during sit-to-stand transfers which are an integral part of daily life [11]. ...
Conference Paper
Full-text available
Mobility impairments can prevent older adults from performing their daily activities which highly impacts a person's quality of life. Exoskeleton technology can assist older adults by providing additional support to compensate for age-related decline in muscle strength. To date little is known about the opinions and needs of older adults regarding exoskeletons as current research primarily focuses on the technical development of exoskeleton devices. Therefore, the aim of this paper is to inform the design of exoskeletons from a human-centered perspective. Interviews were conducted with seven older adults and six healthcare professionals. Results indicated that exoskeletons can be a valuable addition to existing mobility devices. Accepting the need for mobility aids was found to be challenging due to associated stigmas. Therefore, an exoskeleton with a discreet appearance was preferred. Ultimately, the willingness to use exoskeleton technology will depend on personal needs and preferences.
... The provision of MDs represents one way in which a society can support individuals' levels of activity and participation throughout the process of ageing, but studies on MD use in that respect among members of the ageing population in general are scarce. Among the few studies published, occupational therapy researchers in the Nordic countries reported that crutches, wheeled walking frames and wheelchairs were commonly used by older people (Brandt et al., 2003;Dahlin-Ivanoff and Sonn, 2005;Ha¨ggblom-Kronlo¨f and Sonn, 2007) and that their use increases during the ageing process. The situation in new EU member states such as Latvia is, however, largely unknown. ...
Article
Introduction Opportunities for leisure activities and physical mobility are important for the ageing population. Therefore, we aim to describe leisure activities outside the home among very old (over 80 years of age) users and non-users of mobility devices in two European countries. Method Survey data on mobility device use, self-rated physical mobility and leisure activities outside the home were utilised for a Latvian ( n = 225) and Swedish ( n = 314) sample. Differences in type and number of leisure activities were studied between the countries and for four groups of participants according to use/non-use of and level of physical mobility. Results Significant differences in type and number of leisure activities were seen between the national samples and among the participant groups. In general, each participant group in the Swedish sample reported more leisure activities than did those in the Latvian sample. Non-users with good physical mobility reported significantly more leisure activities than all other participant groups. Conclusion There are differences between the two national contexts in the type and number of leisure activities reported. To support very old people’s participation in outdoor leisure activities, we need more knowledge as to how physical, institutional and sociocultural environments affect very old people’s opportunities to engage in and perform such activities.
... Today, the walker is a very common mobility device and is used by approximately 0.7 % of the population (statistics for US in the mid 1990's) [2]. Corresponding statistics for Sweden show almost 4 % [3]. ...
Article
Full-text available
An intelligent rollator (IRO) was developed that aims at obstacle detection and guidance to avoid collisions and accidental falls. The IRO is a retrofit four-wheeled rollator with an embedded computer, two solenoid brakes, rotation sensors on the wheels and IR-distance sensors. The value reported by each distance sensor was compared in the computer to a nominal distance. Deviations indicated a present obstacle and caused activation of one of the brakes in order to influence the direction of motion to avoid the obstacle. The IRO was tested by seven healthy subjects with simulated restricted and blurred sight and five stroke subjects on a standardised indoor track with obstacles. All tested subjects walked faster with intelligence deactivated. Three out of five stroke patients experienced more detected obstacles with intelligence activated. This suggests enhanced safety during walking with IRO. Further studies are required to explore the full value of the IRO.
... Among the non-experimental designs, there were also four surveys and follow-up studies (studies #4 [6], #5 [7], #6 [9] and #13 [19] in Table 1) on rollator or powered wheelchair interventions. The articles did not clearly state whether the design was a cross-sectional survey or not. ...
Article
Full-text available
Background: Therapists need information about assistive technology (AT) outcomes linked to life habits (activities in real life). However, the scientific literature seems to be almost non-existent in many life habit domains, and when it does exist, it may not be relevant to clinics because of the characteristics of the research designs. Objective: To examine what kinds of research designs are used to assess outcomes of AT use in real life situation and to discuss the usefulness of different designs for therapists in clinical practice. Method: A limited search in PubMed and OT Seeker was performed in June 2010 using the keywords "assistive AND technology AND device AND outcome". Results: Of the 499 references found, 19 studies met our inclusion criteria. Six of the research designs were experimental (randomized controlled trial: n=6), four were quasi-experimental (longitudinal: n=2, multiple baseline: n=2) and nine were non-experimental (survey and follow-up: n=4, case study: n=1, case report: n=2, correlational research: n=1, multiple cohort: n=1). Eleven types of AT were assessed. Discussion and conclusion: We found that the studies that give more useful information for therapists in clinics include research designs with short and long term effects of AT, use of standardized tools that point out the possible life habits where AT should be helpful, and a strategy to control confounders (group comparison, alternative condition for AT use, repetitive measures).
... Furthermore, walking performance has been shown to decrease in a sub-population, i.e., Parkinsońs disease patients when using a WW [6]. In general, not all users are satisfied with the WW and usability and accessibility 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. ...
Article
Full-text available
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.
... Som nemnt tidlegare så skal effekt av tiltak helst målast gjennom forskingsdesign så høgt oppe i det medisinske dokumentasjonshierarkiet som mogleg (Helse-og omsorgsdepartementet, 1997). For å imøtekomme dette, er det utført studiar for å måle effekten av innføringa av hjelpemiddel, som mellom anna måler bruksfrekvens av hjelpemiddelet eller tek utgangspunkt i strukturerte spørjeskjema eller kartleggingsinstrument (sjå til dømes Mortenson et al., 2013;Brandt et al., 2003;Mann et al., 1999;Phillips og Zhao, 1993). Slik effektforsking som ser på om hjelpemiddelet faktisk er kausalt ansvarleg for observerbare endringar, har to implisitte føresetnadar som er viktige å løfte fram. ...
... The fourwheel type gait assistance tool that is used for gait by elderly people who are able to walk independently is called a silver-car, and it consists of handle, frame, and stopper. Some of the silver-cars have a seat or a basket that are used for rest or carrying objects 6) . ...
Article
[Purpose] The purpose of this study was to investigate the effect of handle type, which is a fundamental element determining rollator type and the part that directly connects the user to a rollator, on the plantar foot pressure of elderly people during gait, and to examine how the gait of elderly people is affected by variation of the rollator handle. [Subjects] The subjects of this study were 12 elderly women over the age of 65 and 10 young adults who were given sufficient explanation about the objectives and method of this study and volunteered to participate in the study. [Methods] The elderly women learned how to use different types of rollators and performed gait without a rollator and with two types of rollators in a random order on a course that was 10 m long. The young adults, who served as the reference for the plantar foot pressure during gait, performed gait in the same manner without a rollator. [Results] The plantar foot pressure of the elderly people was compared with that of the young adults. The results show that there was a significant difference at the rearfoot, lateral midfoot, lateral forefoot, and hallux regions. The plantar foot pressure at the rearfoot and hallux regions was highest in the young adults, while it was lowest when the elderly used a rollator with a transverse handle. The plantar foot pressure at the lateral midfoot and lateral forefoot regions was highest when the elderly group did not use a rollator. [Conclusion] The results suggest that selective use of the handle type according to the purpose is important even though the use of a rollator assists the gait of the elderly regardless of the handle type. Moreover, the high dependency on the transverse handle rollator means that there can be a greater risk of falling down when grip on the handle is lost, and the vertical handle is more appropriate for gait training since it reduces dependency on the rollator during gait.
... 이러한 원인으로 많은 노인에게서 낙상 및 보행능 력의 상실이 발생하며, 이는 노인의 일상생활 동작 독립성 저하의 가장 심각한 원인 중의 하나가 된다 (Guralink and Kaplan, 1989 (Hwang, 2006). 이러한 보행 보조도구를 사용함에 따라 얻는 이득에는 지지 기저면의 확 장을 통한 안정성의 증대, 저하된 균형능력에 대한 보상 및 체중보조 등이 있다 (Smidt and Mommens, 1980 (Finkel, et al., 1997 (Brandt, et al., 2003). ...
Article
Objective: The purpose of this study is to find the problems of stability when people use the bassinet as an ambulatory aid for old people. Background: Many aged people use a bassinet as ambulatory aid. But the safety of using the bassinet as ambulatory aid has not been verified yet. Method: The 13 university-students who don't have musculoskeletal disorders volunteered to participate in this study. According to structural analysis of the both tools, we compared the structural stability of an outdoor rollator with the structural stability of a bassinet. And when the participants walked using both tools, the motions were captured and analysed. We measured the angle of shoulder joint and the angle of trunk from the ground when the participants were walking. And we found the distance from participants' pressure cone apex and greater trochanter. Results: Following the structural analysis, the bassinet has the lower structural stability than the outdoor rollator. When the people used the bassinet as ambulatory aid, the angle of the shoulder joint was bigger than to use the outdoor rollator. The angle of trunk wasn't different between the outdoor rollator and the bassinet. And distance from pressure cone apex to greater trochanter was far to use the bassinet than to use the outdoor rollator. Conclusion: Through the structure analysis and gait analysis of the bassinet and the outdoor rollator, we can be aware of that the bassinet has problem of stability. Therefore the people who use the bassinet as an ambulatory aid, especially supporting body weight, may be hurt due to the problems of stability. Application: This research can be used for developing a study of the ambulatory aid and preventing the accident when the aged people use the ambulatory aid.
... In a early study, it has been shown that the walking performance in elderly subjects measured in terms of distance, cadence and velocity is improved when they walk with a rollator [7]. And the rollator users are generally satisfied with their rollator and consider it a prerequisite for living a socially active and independent life [8]. ...
Conference Paper
Full-text available
Clinical evaluation of frailty in the elderly is the first step to decide the degree of assistance they require. This evaluation is usually performed once and for all by filling standard forms with macro-information about standing and walking abilities. Advances in robotics make it possible to turn a standard assistance device into an augmented device. The existing tests could then be enriched by a new set of daily measured criteria derived from the daily use of standard assistance devices. This paper surveys existing Smart Walker to figure out whether they can be used for gait monitoring and frailty evaluation, focusing on the user-system interaction. Biomechanical gait analysis methods are presented and com-pared to robotics system designs, to highlight their convergences and differences. On the one hand, monitoring devices try to estimate accurately biomechanical features, whereas, on the other hand, walking assistance and fall prevention do not systematically rely on an accurate human model and prefer heuristics on the user-robot state.
Article
Purpose: The aim of this literature review was to identify and summarize aspects of the usability of rollators from the currently available research literature. Further objectives were the exploration of rollator requirements and the search for possible disciplinary differences in the consideration or elaboration of usability aspects. Materials and Methods: Following the PRISMA guidelines, the databases CINAHL, Pubmed and Academic Search Elite were examined in the period from April - May 2023. For the synthesis of the quantitative and qualitative data and the identification of prominent themes in this work, a theory driven thematic analysis approach was used. Results: A total of 45 publications were included (25 quantitative, 14 mixed methods, 6 qualitative) from various disciplines, the majority belonging to physiotherapy 42%, followed by engineering 16% and health sciences 16%. Aspects of usability were extracted using a deductive code catalogue based on QUEST 2.0. The categories "easy to use" (28/126), "comfort" (20/126), and "safety" (14/126) were most frequently assigned. While "repairs & servicing" (5/126), "service delivery" (4/126), and "durability" (3/126) were coded least frequently. Conclusion: So far, no specific publications on the usability of rollators has been published, which made it necessary to summarize individual usability aspects using a deductive code catalogue. The results obtained, therefore, do not allow any generalized statement about the usability of rollators. However, this initiates discussions about the usability of rollators that should be studied in the future in a participatory and user-centred manner and, placing satisfaction more in the focus of usability engineering and evaluation of rollators.
Article
Purpose: QUEST2.0 is a practical tool specifically applied to assessing the satisfaction for awide array of assistive technology in a standard manner. Therefore, this study set to translate and evaluate the validity and reliability of the Iranian version of the QUEST2.0in Persian-speaking users of manual and electronic wheelchairs in Iran. Methods: The present study recruited 130 users of manual and electric wheelchairs. Psychometric properties, including; content validity and construct validity and internal consistency and test-retest reliability, were testified. Results: The content validity index of the questionnaire was 92%. The internal consistency was determined to be 0.89,0.88 and 0.74, respectively, for the whole questionnaire and dimensions of the device, and services. The test-retest reliability was 0.85, 0.80, and 0.94, respectively, for the whole questionnaire and dimensions of the device and services. Factor analysis confirmed the two-factor structure of the questionnaire. In the two-factor model, 57.75% of the total variance was explained by these two factors, of which 45.8% pertained to the first factor (device) and 11.95% to the second factor (service). Conclusions: The results showed that QUEST2.0 had both valid and reliable for measuring satisfaction with assistive technology among wheelchair users. The assessment will also help facilitate the quality improvement processes in using assistive technology devices.IMPLICATIONS FOR REHABILITATIONThe Iranian version of the QUEST2.0 (IR-QUEST2.0) is an appropriate validity and reliability for measuring satisfaction with assistive technology among wheelchair users.Not only does the IR-QUEST2.0 can help identify the contributing factors of dissatisfaction among wheelchair users, it facilitates the quality improvement processes of AT devices as a guidance which ultimately meet or enhance customer satisfaction.
Article
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Objective The purpose of this systematic review is to assess the impact of assistive devices on the life satisfaction of (Research Question 1), and informal caregiving hours received by (Research Question 2), community-dwelling older adults (≥ 65 years). Methods We searched CINAHL, MEDLINE, and Scopus from database inception to March 2022. For each question, two reviewers independently screened citations, extracted and narratively synthesized the data, and assessed article quality and strength of evidence. Results Of the 1391 citations screened, we found two articles pertaining to each question, for a total of four articles. In general, assistive device use was not associated with life satisfaction, while it was positively associated with informal caregiving hours. However, the risk of bias was serious across the two studies for Research Question 1, and the overall quality of evidence was “very low”. The risk of bias was not serious across the two studies included in Research Question 2 and the overall quality of evidence was “low”. Conclusion Due to the scarcity of studies, the limitations of existing studies (i.e., risk of bias), and the evidence being low or very low quality, we could not draw firm conclusions about the associations of interest. Additional research will produce a better understanding of the two relationships and provide further evidence to inform policy decisions regarding the provision and funding of assistive devices for community-dwelling older adults. Trial registration This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database of systematic reviews (identification number: CRD42021248929 ).
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Objectives: Gait parameters can measure risks of falling and mortality and identify early stages of frailty. The use of walking aid changes gait parameters. To identify what a dysfunctional gait is, one must be able to define what a normal gait is both with and without a walking aid. The aim of this study was to describe differences in gait parameters among healthy adults when walking on different surfaces and under different conditions, with and without a rollator. Results: Ten healthy participants walked first without and then with a rollator upslope, downslope and on flat surface, on bitumen and gravel respectively. Step length, walking speed and sideway deviation was measured using an inertial measurement unit. Walking up a slope using a rollator generated the longest step length and walking down a slope using a rollator the shortest. Fastest walking speed was used when walking up a slope with rollator and slowest when walking down a slope with rollator. Sideway deviation was highest when walking down a slope and lowest when walking on gravel, both without rollator. Data from this study provides valuable knowledge regarding gait parameters among healthy individuals, useful for future clinical research relevant for rehabilitation and public health.
Chapter
Mobility is fundamental for living. As walking is the most common form of mobility for humans, disorders of gait impact multiple aspects of our existence, including independence, social function, health, and the ability to explore and understand ourselves in relation to the world. Because of the breadth of the impact of gait disorders, the intent of this chapter is to provide clinicians with an adequate background in the basic physiology and mechanics of normal gait, and an observational approach to recognize deviations from the normal pattern-types of gait abnormalities. While the type of gait disorder does not directly lead to the treatment prescription, we describe various approaches to the management (including assistive devices) and rehabilitation that may have potential to impact related gait abnormalities. Lastly, we highlight rising concerns and directions in the assessment and management of subclinical gait problems in walking.
Chapter
Digitale Methoden der Industrie 4.0, die sich bereits für technische Systeme etabliert haben, können auch auf die Lebenswissenschaften bzw. auf die Biomechanik übertragen werden. In Abb. 1 werden exemplarisch einige computergestützte Verfahren aus der technischen Anwendung auf den Bereich der biologischen Systeme transferiert. Im Detail wird die Überwachung eines Bremssystems und des menschlichen Bewegungsapparats betrachtet.
Article
The use of gait assistive devices, although can provide precious help can also have limitations or adverse consequences. The performance of daily activities is partially restrained by a series of factors having to do with the assistive device limitations or the limitations emerged from environmental causes. Valid and reliable assessment tools to classify and clarify their limitations or users' satisfaction do not exist. An extended literature search was performed for some of the most commonly mentioned assistive device limitations or dissatisfaction reasons and identified the most appropriate tools to be able to study such limitations and conclude in valid outcomes. A study was conducted in a rehabilitation hospital using the IPA, EQ5D and SF-12 tools. The size of the sample combined with the uncertainty related to the satisfaction of normal distribution prerequisite, led to use several statistical analysis tools and methodologies. A summary of the results from both the literature review and the real case study on a mixed group of mobility aid users are presented in the paper.
Article
A wheeled walking aid with an embedded controlled braking system is described. The frame of the prototype is based on combining features of standard available wheeled walking aids. A braking scheme has been designed using hydraulic disc brakes to facilitate accurate and sensitive controlled stopping of the walker by the user, and if called upon, by automatic action. Braking force is modulated via a linear actuating stepping motor. A microcontroller is used for control of both stepper movement and for supervisory control. An encoder is used to supervise walker movement in terms of time, distance and speed.
Article
For older people mobility and participation in activities can be restricted both by individual factors and by the environment. The aim of this paper was to examine the longitudinal impact of measures taken in the outdoor environment on an ageing population. The following factors were examined on three occasions over a nine-year period: frequency of walking; differences in report on environmental barriers; and reported valuation of the outdoor environment; and how these relate to different characteristics. At the second follow-up, the respondents experienced more functional limitations and more were using mobility devices than at baseline. At the first and second follow-up, the respondents did not experience as many environmental barriers in their outdoor environment compared to baseline. However, frequency of walking and evaluation of the outdoor environment decreased in general between baseline and first- and second follow-up. A quite promising result from the study is that compared to people not using mobility devices, mobility device users were more likely to be frequent walkers at first- and second follow-up than at baseline. Likewise, at second follow-up respondents having functional limitations were less likely to experience traffic barriers than at baseline. In terms of accessibility, usability and mobility for an ageing population, the results are promising, showing that measures in the outdoor environment can possibly facilitate walking for those who are more fragile, even in a longitudinal perspective.
Article
Purpose This study aimed at clarifying the actual use of and satisfaction with rollators and “shopping carts” (wheeled walkers with storage) among frail elderly people, who were certified by a long-term care insurance system as users of facilities that provide day-service nursing care and rehabilitation. Methods We identified 1247 frail elderly people who used day-service facilities, and evaluated their actual use of, and satisfaction with, rollators and shopping carts. Results Forty-four (3.5%) individuals used rollators, and 53 (4.3%) used shopping carts. The shopping cart group contained more individuals who were certified as care level 1 (26.4%), than the rollator group (20.5%), and 52.8% of the shopping cart group was certified as care levels 1–3. The scores for “repairs and services” and “follow-up” from the Quebec User Evaluation of Satisfaction with assistive Technology second version (QUEST 2.0) survey were significantly higher in the rollator group than in the shopping cart group. Conclusions The QUEST 2.0 scores revealed that shopping cart users exhibit insufficient “repairs and services” and “follow-up” scores. As frail elderly people with poor care status accounted for >50% of the shopping cart group, these individuals urgently need walking aids that are tailored to their care status. • Implications for Rehabilitation • We conclude that walking aid fitting must be tailored to each persons care status, and suggest that a system should be established to allow occupational or physical therapists to provide this fitting • Moreover, our analysis of the QUEST2.0 service scores revealed that repairs, services, and follow-up are insufficient to meet the needs of shopping cart users.
Article
Aim: To describe outdoor barriers in the nearby home environments of very old people, and to investigate whether the presence of these environmental barriers differed between users and non-users of mobility devices (MDs). Method: Baseline data on 397 Swedish people aged 80-89 years, collected with a study-specific question on MD use and a subset of the environmental component of the Housing Enabler instrument, assessing the outdoor environment nearby home, were used. Descriptive statistics were used for data analysis. Results: The most frequent outdoor environmental barriers nearby home concerned walking surfaces, level differences, manoeuvring spaces, seating and shelters. There were however no differences in the number of outdoor environmental barriers nearby home between users and non-users of MDs. The largest difference in presence for specific barriers in the nearby outdoor environment between users and non-users of MDs were for example complicated or illogical routes to/from the entrance, steep gradients, and letterboxes possible to reach only via steps or other differences in level. Conclusion: Even if the number of environmental barriers does not differ, there are differences between users and non-users of MDs regarding specific barriers. This implies that it is not the number of environmental barriers present that matters, but rather specific barriers that impact on MD use among very old people. For that reason, it is important to consider detailed information on environmental barriers as well as personal functioning to support performance of outdoor activities in everyday life for the ageing population.
Conference Paper
This paper reports on a pre-post study on outcomes of rollator interventions in terms of mobility-related participation frequency and ease, and of users perceptions of the importance of the device Data were collected in two municipalities with 37 and 38 respondents, in average 77 and 82 years of age Taking walks became more frequent and easier, and in one of the municipalities it also became easier to go to the pharmacy, the post office and the library, to do shopping and to visit families and friends Most users considered their device to be Important, but there was an increased risk that the oldest users would not rate the device as Important Reasons for modest outcomes and for municipality differences are discussed
Article
Points essentiels L’abandon du déambulateur peut être secondaire à une prescription initiale inappropriée, à un entraînement insuffisant, à l’absence de suivi et aux effets secondaires de l’aide. L’amélioration de la stabilité et de la mobilité chez les utilisateurs de déambulateur est le fait de plusieurs mécanismes biomécaniques. Les avantages du déambulateur : effets physiologiques généraux, davantage de confiance, meilleure vie sociale et diminution de la charge de soins. Les inconvénients : aspects techniques ou pratiques critiqués par les utilisateurs, troubles musculosquelettiques, temps de réaction retardé, risque de chute et stigmatisation. Le peu ou les très rares données scientifiques de bonne qualité, évaluant l’intérêt du déambulateur comme dispositif d’amélioration de la mobilité, font que les recommandations autour de son utilisation sont de bas grade car souvent issues de l’expérience clinique des professionnels. L’aide technique à la marche la plus appropriée peut être choisie en fonction de la pathologie ou du mécanisme biomécanique à l’origine du trouble de la marche. Les déambulateur-robots sont encore de diffusion marginale.
Article
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. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) is a 12-item outcome measure that assesses user satisfaction with two components, Device and Services. Psychometric properties have been tested with respect to test-retest stability. alternate-form equivalence. internal consistency, factorial composition and nomological validity. Examples of results obtained with the first version of the tool in outcome studies in Europe and North America support the importance and relevance of the satisfaction measure.
Article
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The purpose of this study was to quantify and compare cardiorespiratory demands imposed during unassisted ambulation and ambulation with various assistive devices in older adults. Ten volunteers (3 male, 7 female) who were not dependent on assistive devices for ambulation, with a mean age 60.3 years (SD = 8.4, range = 50-74), participated. Immediately after a 5-minute steady-state session with each of the assistive devices tested (standard walker, wheeled walker, and single-point cane), subjects ambulated for 2 minutes at a self-selected speed with each device and unassisted while selected cardiorespiratory and metabolic variables were monitored. Ambulation with the use of a standard walker was shown to require 212% more oxygen per meter than unassisted ambulation and 104% more oxygen per meter than ambulation with a wheeled walker. Ambulation with a standard walker elicited 200% and 98% higher heart rate per meter as compared with unassisted ambulation and ambulation with a wheeled walker, respectively. No difference was detected for physiologic demands between unassisted ambulation and ambulation with a cane. The decision to prescribe a wheeled walker versus a standard walker may be clinically important with patients who have impaired cardiorespiratory systems.
Article
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We compared uptake of hospital and community-based support in elderly people disabled by chronic obstructive pulmonary disease (COPD), normal controls (NCs) and patients with Parkinsons disease, stroke, amputation, or arthritis (disabled controls; DCs). There were 65 subjects (35 men) aged 70-93 years (mean 78) with COPD, 55 NCs [23 men; age range 71-90 years (mean 78)] and 53 DCs [27 men; age range 70-92 years (mean 78)]. Patients with COPD and DCs were outpatients with Nottingham extended activities of daily living (NEADL) score < 16. NCs came from a community survey. Subjects with COPD were clinically stable. All were cognitively intact. Mean NEADL scores (and range) were: 10.2 (3-15) for patients with COPD, 9.4 (3-15) for DCs (t=1.14, P=0.26) and 19.0 (11-21) for NCs. There was no difference in meals-on-wheels, district nurse or hospital or physiotherapy provision between patients with COPD and NCs, but those with COPD received more home care (P < 0.01). DCs received more home care (P=0.04), more district nurse input (P < 0.001) and more physiotherapy (P < 0.0001) than those with COPD. Despite moderate or severe disability, elderly patients with COPD receive little statutory domiciliary support. Reasons for this need further exploration.
Article
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Two consecutive studies addressed device use post-discharge in relation to functional status among 47 persons with mixed diagnoses discharged from an acute inpatient rehabilitation unit. Telephone interviews were used to ascertain device use; functional status was obtained using the telephone version of the Functional Independence Measure (FIM). Among all participants, 128 devices were prescribed; of these, 86 devices were still used at 3-month follow-up. The four types of devices most frequently abandoned were adapted grooming aids (55% nonuse), quad canes (43%), walkers (36%), and manual wheelchairs (36%). The most frequent reason given for nonuse was that the device was no longer needed. In study two, it was found that functional improvement (at follow-up) corresponded with device nonuse for about half the devices. The study also documented discrepancies in perception between therapists and consumers regarding utility and aesthetic aspects of devices. Strategies to maximize appropriate use of devices are presented.
Article
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Technology abandonment may have serious repercussions for individuals with disabilities and for society. The purpose of this study was to determine how technology users decide to accept or reject assistive devices. Two hundred twenty-seven adults with various disabilities responded to a survey on device selection, acquisition, performance, and use. Results showed that 29.3% of all devices were completely abandoned. Mobility aids were more frequently abandoned than other categories of devices, and abandonment rates were highest during the first year and after 5 years of use. Four factors were significantly related to abandonment--lack of consideration of user opinion in selection, easy device procurement, poor device performance, and change in user needs or priorities. These findings suggest that technology-related policies and services need to emphasize consumer involvement and long-term needs of consumers to reduce device abandonment and enhance consumer satisfaction.
Article
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More people use assistive technology devices to compensate for mobility impairments than for any other general type of impairment. Increasing numbers of people with mobility or balance problems use walkers with four wheels. Four-wheeled walkers are often outfitted with seats to make it possible to travel longer distances with intermediate resting periods. The dangers of sitting on a parked walker are well known. Many physiotherapists tell walker users to park the walker against a wall to prevent injury in case the user forgets to apply the brakes or the brakes fail. To design a safer walker that can be used for sitting, the demands placed on it must be measured. With these data, three modes of walker instability must be considered: first, the brakes may hold but the wheels may slide along the ground; second, the entire walker may tip over; and third, the brakes may fail to hold the wheels in place, and they may begin to roll. Mathematical models can be constructed to simulate how different walker designs will perform. By this process, design improvements can be made for existing walkers, and future walker designs can also be proposed.
Article
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high walking frames may improve exercise capacity in young patients with chronic obstructive pulmonary disease (COPD). We have assessed the effect of Zimmer, rollator and gutter frames on 6-min walking distance and on arterial oxygenation during exercise in elderly patients with COPD. 27 out-patients (15 men) aged 70-82 (mean 75) years were recruited. Exclusions comprised: COPD exacerbation or oral steroid use within 6 weeks, confusional state, participation in a pulmonary rehabilitation programme and exercise limitation by other diseases. Subjects completed 6-min walk tests unaided and with the three frames on four separate days in random order 30 min after nebulized salbutamol (5 mg) and ipratropium (0.5 mg) and were accompanied by an investigator blinded to results of all other walk tests undertaken. Oxygen saturation (SaO2) was monitored by finger probe during exercise. Grouped t-tests were used to compare distances and reductions in SaO2. Unaided, the mean (SEM) 6-min walk distance was 210 (16) m and fall in oxygen saturation was 6.0 (1.1)%. Use of a rollator frame did not significantly affect either of these values. Using the Zimmer frame reduced the mean distance to 165 (13) m (t=5.2, P < 0.001 vs unaided walk) with an SaO2 fall similar to that recorded during the unaided walk. Using the gutter frame increased the mean distance to 234 (150) m (t=3. 1, P=0.004 vs unaided walk) and reduced the fall in SaO2 to 3.7 (0.8)% (t=2.3, P=0.03 vs unaided walk). gutter frames improve exercise capacity and SaO2 during exercise in elderly COPD patients who remain symptomatic on optimal therapy, whereas unwheeled Zimmer frames have a deleterious effect in such patients.
Article
This study used data files from the National Health Interview Survey (NHIS), 1990: Assistive Devices Supplement sample of 117,042 adults from the 50 states and the District of Columbia. A subsample of 3,297 persons aged 65 years and older was selected on which to perform secondary analysis on the association of self-reported health status, activity limitation, total number of devices reported, and demographic variables. Twenty-three percent of persons aged 65 and older reported any assistive device. Black respondents reported more activity limitations than respondents from other races, but there was no relationship among race and total devices reported. Greater percentages of women than men have more activity limitations as well as report more than one device. Persons not living with a spouse reported more than one device. Reports of a higher total number of devices correlated with poorer health status and greater activity limitations. A weak correlation was found between higher total number of devices reported with lower income level and with greater age. In addition, subjects with fewer activity limitations reported better health status and high levels of education. Weak correlations were found between fewer activity limitations with higher income, as well as with greater age.
Article
The purpose of the study was to provide knowledge, from a user perspective, about the selection process for assistive devices. Thirty-eight persons who had suffered stroke were interviewed about their assistive devices, approximately one year after stroke. It was found that the patients had little influence on the choice of assistive devices and that the maintenance and follow-up routines varied among patients. In some cases follow-up was not done at all. Despite these deficits, the patients used their assistive devices as intended.
Article
In the United States, over 1.5 million persons use walkers, and 77 percent are 65 or older. Yet walkers rank high in terms of numbers of users experiencing problems in their use. This paper provides an overview of walker designs and features a review of the literature on studies of walkers and walker use, and an analysis of walker problems experienced by subjects in the University at Buffalo Consumer Assessments Study (CAS). Of 333 subjects in the CAS at the time of this analysis, 324 subjects reported at least some difficulty with ambulation, and 69 used a walker. Forty-two of the walker users reported problems relating to 46 walkers they owned. Fifty-seven percent of the problems were categorized as "difficult and/or dangerous" to use, pointing to the need for careful professional assessment, prescription and follow-up. A relatively small percentage (4 percent) of walker owners cited stigma as a problem.
Article
Stroke patients who require a walking aid usually use a cane since the recovery of the affected upper extremity is insufficient to allow the use of a bilateral device. A sample group of 61 consecutive stroke patients admitted to rehabilitation received remedial treatment to their affected upper extremity, concentrating on the movements required for pushing a wheeled walker. Eighty-six percent of the patients who regained their walking ability were able to use a wheeled walker. The motor and functional recovery of the upper extremity of these patients was followed up and found to improve significantly. The aim of this study is to propose the wheeled walker as a useful walking device, which assists in the treatment, maintenance and reintegration of the affected upper extremity into daily function.
Article
Occupational therapists often prescribe assistive technology devices (ATDs) to assist persons with disabilities in performing daily living tasks. Estimates suggest that although most ATDs are used, a substantial proportion are never used or are discarded shortly after they are obtained. A review of the literature on ATDs was carried out to identify factors that contribute to ATD use and disuse. The review focused on persons with osteoarthritis and rheumatoid arthritis, because such persons are frequent users of ATDs. Although the literature review highlighted person-, environment-, and ATD-related factors as relevant to ATD use, it also underscored the dearth of scientific study of the prescription, provision, and use of ATDs. A model is proposed to guide empirical research aimed at identifying non-device users from the outset of treatment so that interventions to improve ATD use may be initiated or alternative interventions implemented. The variables comprising the model pertain to the patient, the patient's living environment, the therapist prescribing the device, and the device itself.
Article
There are few data on the effect of walkers on gait and mobility or on comparisons of different walker types. We compared a commonly used 4-legged, 2-wheeled walker and a newer 3-legged, 3-wheeled walker in measures of gait, mobility, and patient satisfaction. Cross-over controlled trial. In the Physical Therapy Department of a Veterans Affairs hospital. Subjects were 15 male and female frail elderly veterans (mean age, 82 years), both inpatients and outpatients, consecutively enrolled from a sample of 35 patients referred to the Physical Therapy Department for mobility problems. Subjects met the following criteria: age 65 or over, ambulatory, no prior use of a wheeled walker, stable medical condition, and informed consent. Subjects were evaluated without either walker and with each of the two walkers on a 15-foot walkway and a 60-foot obstacle course. Subjects were asked which walker they preferred. Outcome measures were stride length on the walkway, time on an obstacle course, and walker preference. Stride length was 1.4 inches (3.6 cm) greater with the 3-wheeled walker than with the 2-wheeled walker (P = 0.016 by Wilcoxon signed-rank test). Time on the obstacle course was 16.0 seconds less with the 3-wheeled walker than the 2-wheeled walker (P = 0.002). The 3-wheeled walker was subjectively preferred. The 3-wheeled walker appears to have a greater positive impact on gait and mobility than the 2-wheeled walker.
Article
The growing elderly population will increase the need for assistive technology in the form of technical aids and housing adaptations to facilitate independence in activities of daily living. In this study, which was undertaken to facilitate a better understanding of the life-styles of the disabled elderly and the role of technical aids, 57 disabled persons over 74 years of age were studied. All of the subjects were residents of a rural Swedish community. The subjects had a total of 422 aids, an average of 7.4 per person. Seventy-five percent of the aids were being used, and 42 persons had at least one aid that granted autonomy. This finding illustrates the importance of technical aids in home care. It is recommended, therefore, that information about assistive technology be disseminated to personnel at all levels of community-based care.
Article
Canes, crutches and walkers are safe and effective but generally underutilized therapeutic tools. These aids are most helpful to patients who have an unstable gait, whose muscles are weak or who require a reduction in the load on weight-bearing structures. An understanding of the biomechanics of ambulation aids provides insights into how and when these devices should be prescribed. The patient must have sufficient strength, balance and coordination to master the aid and should be trained to use it correctly.
Article
The longitudinal Intervention Study of the Elderly in Göteborg, Sweden (IVEG), has provided an opportunity to report on the use of assistive devices in activities of daily living (ADL) in a subsample of elderly persons living in their own homes, who were interviewed at the ages of 70 and 76 (n = 371). Type, frequency, usage rate and effectiveness of assistive devices was studied among all 76-year-olds involved in the IVEG study (n = 595). One-fifth at the age of 70 and almost half of the population at 76 had assistive devices, most frequently in connection with bathing and mobility. A higher percentage of females and subjects living alone used assistive devices compared to men and cohabitants. The longitudinal study showed that 31% developed a need for assistive devices between 70 and 76 years of age, 15% used assistive devices both at 70 and 76 years, while 50% had no devices at 70 or at 76 years of age. The usage rate was high (90%), and a high degree of effectiveness was found, particularly in the form of an increment in safety and a decrement in effort in the various activities.
Article
A method for quantifying the stability of a patient using a walking frame is presented. Data collected from a walker-dependent patient recovering from surgical amputation of his right leg were used to demonstrate the derivation and interpretation of a proposed walker user risk index (WURI). WURI curves express risk to the walker user in terms of how much the upper extremities contribute to overall patient support. The WURI analysis of the walker stride presented here quantified the expected clinical impression that this patient was least reliant on the walker immediately after the advance of his prosthetic leg and most reliant when standing on his prosthesis and swinging his nonamputated leg. The analysis also revealed unexpectedly high upper body loads and specific phases in the gait cycle where the patient's balance was at risk.
Article
A key strategy in rehabilitation with the elderly is the selection and training in the use of adaptive devices to improve the ability to perform self-care and other activities of daily living. Two descriptive pilot studies were conducted to determine home use of equipment from the perspective of older adults with mixed disabilities and home care therapists. The first study examined home equipment use over a three-month period by 13 elderly patients discharged from a hospital rehabilitation unit. The second study surveyed 31 home therapists to evaluate their perceptions of device use by their elderly clients. The findings indicate that older adults and home care therapists share similar perspectives as to why devices are not frequently used. Home care therapists perceived that additional training in a person's home may increase safety, maximize functional performance, and reduce some caregiver responsibilities. The implications of these findings for service delivery are discussed.
Article
A crucial need in assistive technology delivery is follow-up to determine device performance and satisfaction from the individual with a disability's perception. As part of an overall research project on technology transfer, this investigation was designed to measure and document service delivery outcomes, first in a pilot study at the Rehabilitation Engineering Center (REC), Lucile Salter Packard Children's Hospital at Stanford (LSPCH) with 60 consumers and then in a replication study in four other service delivery centers providing devices to 103 clients. One hundred sixty-three devices were delivered to 163 consumers by five service delivery centers. The results of this investigation indicate that user feedback can be documented through prospective and standardized data collection forms; outcome measures can be helpful in determining user satisfaction and device performance; user responses, compared with clinician evaluations, are reliable perceptions of device performance; provision of the selected assistive devices was demonstrably positive for the majority of device users; and for those individuals not initiating return visits, the phone-call follow-up provided information that would not have been available otherwise to the service providers.
Article
This study's purpose was to develop a clinical instrument designed to evaluate user satisfaction with assistive technology devices. This paper describes the methodology used to develop the instrument entitled the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Based on the theoretical and practical foundations of assistive technology as well as on the concept of satisfaction, preliminary versions of the instrument were created and examined by a panel of team participants. After the panel's recommendations were incorporated, a pretest of the revised instrument was conducted and the final French version of QUEST emerged. The originality of QUEST lies in its inter-activeness and user-directed approach to assessing satisfaction with assistive technology. From a set of 27 variables, the user is asked to indicate the degree of importance he/she attributes to each of the satisfaction variables and then to rate his/her degree of satisfaction with each of the variables considered (quite or very) important. While QUEST remains a clinical instrument undergoing pilot testing, it holds much promise in our quest for a reliable and valid means of assessing assistive technology outcome from the user's perspective.
Article
To investigate the measurement properties of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0) with respect to test-retest stability, alternate form reliability, construct validity and applicability. Data on satisfaction and quality of life impacts of mobility devices were obtained from 81 community-based adults with Multiple Sclerosis, using the QUEST 2.0 and the Psychosocial Impact of Assistive Devices Scale (PIADS). Subjects were assigned to four groups and a second QUEST 2.0 was administered one week later. Groups differed with respect to the format and the order in which alternate forms were presented. Measures of association were calculated between QUEST 2.0 and PIADS (n = 81) and between QUEST 2.0 alternate forms (n = 48). Respondents' reactions were considered. The device subscale, services subscale, and total QUEST 2.0 scores achieved good test-retest stability (ICC 0.82, 0.82, 0.91). Alternate-form equivalence (ICC 0.89, 0.76, 0.91) was lower for services. The positive correlations between QUEST 2.0 and the three PIADS dimensions were fair to moderate for device and total QUEST 2.0 (r(p) 0.34 to 0.45) and fair with services (r(p) 0.27 to 0.30). The tool was positively received, with some restrictions for the services subscale. These findings on the psychometric properties of the QUEST 2.0 reinforce the relevance of the device subscale as an important outcome measure for assistive technology MS users. Further assessment of the services subscale is needed.
Article
In order to increase the theoretical understanding of the concept of accessibility, this paper reports the results from an exploration of methodological difficulties inherent in systematic accessibility assessments of single persons' travel chains in urban public bus transport. In addition, Special Transport Service (STS) travellers' perception of environmental demands in public transport are reported. This study was designed to explore the environmental component in accessibility problems systematically. Twenty persons entitled to STS were recruited in order to travel by low-floor bus, Service Route Traffic (SRT) or STS. Two different methods were chosen. Critical incidents were collected during participant observation, and by means of a pilot instrument based on the Enabler Concept independent environmental assessments were performed. Not all environmental details registered during the participant observations were in agreement with the independent environmental assessment, and different reasons for the disagreements were reported. In addition, participants travelling by STS gave information about what hindered them from using conventional public transport. The theoretical understanding behind accessibility assessments has benefited from the methodological challenges mapped out in this study. In order to interpret accessibility, the individual perspective as well as the population perspective are necessary, which means that complementary methods are needed.
Quebec User Evaluation of Satisfaction with assistive Technology QUEST version 2.0. An outcome measure for assistive technology devices Assistive technologies in stroke rehabilitation from a user perspective
  • Demers L R Weiss-Lambrou
  • U Ska B Hass
  • I Frede´
  • Persson
22 Demers L, Weiss-Lambrou R, Ska B. Quebec User Evaluation of Satisfaction with assistive Technology QUEST version 2.0. An outcome measure for assistive technology devices. Webster, New York, USA: The Institute for Matching Person & Technology, 2000. 23 Hass U, Frede´ I, Persson J. Assistive technologies in stroke rehabilitation from a user perspective. Scandinavian Journal of Caring Science 1996; 10: 75 – 80.
Cross-cultural' adaptation of QUEST and its application as a routine follow-up within the service delivery process Opfølgningen i formidlingen halter. Hvordan, hvorfor – hvorfor ikke? (in Danish)
  • L 33 Wessels Rd
  • Demers R L Weiss-Lambrou
  • B Ska
  • Dansereau
  • C Christensen
  • A Bendixen
  • E Pe´
  • Gregersen
33 Wessels RD, deWitte L, Weiss-Lambrou R, Demers L, Ska B, Dansereau J. 'Cross-cultural' adaptation of QUEST and its application as a routine follow-up within the service delivery process. Canada: WFOT Conference, 1998. 34 Christensen C, Bendixen A, Pe´ E, Gregersen A. Opfølgningen i formidlingen halter. Hvordan, hvorfor – hvorfor ikke? (in Danish). Viadukt 1998; 4: 8 – 10.
Measuring outcomes of assistive technology use through mixed methods 28 Scherer M. The Matching Person and Technology (MPT) Model, second edition Adaptive device use by older adults with mixed disabilities
  • M Scherer
  • Cushman La
  • Ln Gitlin
  • R Levine
  • Geiger
27 Scherer M, Cushman LA. Measuring outcomes of assistive technology use through mixed methods. Archives of Physical Medicine Rehabilitation 1994; 75: 726. 28 Scherer M. The Matching Person and Technology (MPT) Model, second edition. New York: Institute for Matching Person & Technology, 1994. 29 Gitlin LN, Levine R, Geiger C. Adaptive device use by older adults with mixed disabilities. Archives of Physical Medicine Rehabilitation 1993; 74: 149 – 152.
A Dutch version of QUEST (D-QUEST) applied as a routine follow-up within the service delivery process Improving the Quality of Life for the European Citizen
  • L 32 Wessels Rd
32 Wessels RD, deWitte L, Weiss-Lambrou R. A Dutch version of QUEST (D-QUEST) applied as a routine follow-up within the service delivery process. In: E Placencia, E Ballabio (eds) Improving the Quality of Life for the European Citizen. Washington DC: IOS Press, 1998; 420 – 424.
Edinburgh: Churchill Livingstone, 1997. Rollators among community-living users 353 Disabil Rehabil Downloaded from informahealthcare
  • Abramsom
38 Abramsom JH. Survey Methods in Community Medicine, fourth edition. Edinburgh: Churchill Livingstone, 1997. Rollators among community-living users 353 Disabil Rehabil Downloaded from informahealthcare.com by SUNY State University of New York at Stony Brook on 11/01/14 For personal use only.
The basic demography: sources and methods used in annex 1 of 'Maintaining prosperity in an ageing society
  • P Hemmings
Hemmings P. The basic demography: sources and methods used in annex 1 of 'Maintaining prosperity in an ageing society'. Available at: http://www.oecd.org/oecd/pages/home/displaygeneral.html.
Offentlige tilskud på hjalpemiddelområdet (in Danish)
  • Amtsrådsforeningen
Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) (in Danish) Copenhagen: Hjælpemiddelinstituttet
  • L Deniers
  • R Weiss-Lambrou
  • B Ska
A Dutch version of QUEST (D-QUEST) applied as a routine follow-up within the service delivery process
  • R D Wessels
  • L Dewitte
  • R Weiss-Lambrou
Wessels RD, deWitte L, Weiss-Lambrou R. A Dutch version of QUEST (D-QUEST) applied as a routine follow-up within the service delivery process. In: E Placencia, E Ballabio (eds) Improving the Quality of Life for the European Citizen. Washington DC: IOS Press, 1998; 420 -424.
Ældres farden udendørs-i Herning, Horsens og Randers (in Danish) Copenhagen: Hjælpemiddelinstituttet
  • Å Brandt
The Matching Person and Technology (MPT) Model, second edition
  • M Scherer
Scherer M. The Matching Person and Technology (MPT) Model, second edition. New York: Institute for Matching Person & Technology, 1994.
Rollatorns betydelse for äldre kvinnor i ordinärt boende (in Swedish) Välling by, Sweden: Hjälpsmedelsinstitutet
  • L Jönsson
Consumer survey into complaint about rollators Assistive technology-Added Value to the Quality of Life
  • M Raijmakers
Survey Methods in Community Medicine
  • Jh Abramsom
Befolkningsprognose for Danmark
  • Danmarks Statistik
The effect of walking aids on exercise capacity in elderly patients with chronic obstructive pulmonary disease
  • J Roomi
  • Am Yohannes
  • Mj Conolly
Predictors of assistive technology abandonment
  • B Philips
  • H Zhao
Quebec User Evaluation of Satisfaction with assistive Technology QUEST version 2.0. An outcome measure for assistive technology devices
  • L Demers
  • R Weiss-Lambrou
  • B Ska
Demers L, Weiss-Lambrou R, Ska B. Quebec User Evaluation of Satisfaction with assistive Technology QUEST version 2.0. An outcome measure for assistive technology devices. Webster, New York, USA: The Institute for Matching Person & Technology, 2000.
A comparison of a twowheeled walker and a three-wheeled walker in a geriatric population
  • J Mahoney
  • R Euhardy
  • M Cames
Cross-cultural' adaptation of QUEST and its application as a routine follow-up within the service delivery process
  • R D Wessels
  • L Dewitte
  • R Weiss-Lambrou
  • L Demers
  • B Ska
  • J Dansereau
Wessels RD, deWitte L, Weiss-Lambrou R, Demers L, Ska B, Dansereau J. 'Cross-cultural' adaptation of QUEST and its application as a routine follow-up within the service delivery process. Canada: WFOT Conference, 1998.
Opfølgningen i formidlingen halter. Hvordan, hvorfor-hvorfor ikke? (in Danish)
  • C Christensen
  • A Bendixen
  • E Pétursdottir
  • A Gregersen
Sundhed og sygelighed i Danmark 1994 -og udviklingen siden
  • Dike
  • Danish
DIKE. Danish Health and Morbidity Survey. Sundhed og sygelighed i Danmark 1994 -og udviklingen siden 1987 (in Danish). Copenhagen: DIKE, 1995.
Rollatorns betydelse fo¨r a¨ldre kvinnor i ordina¨rt boende
  • L Jö Nsson
Jö nsson L. Rollatorns betydelse fo¨r a¨ldre kvinnor i ordina¨rt boende (in Swedish). Va¨llingby, Sweden: Hja¨lpsmedelsinstitutet, 1999.
AEldres faerden udendørs -i Herning, Horsens og Randers
  • Å Brandt
Brandt Å. AEldres faerden udendørs -i Herning, Horsens og Randers (in Danish). Copenhagen: Hjaelpemiddelinstituttet, 2000.