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Su TT, Mejía ST. Capturing multiple assistive technology use and its impact in later life: lessons learned from distinct measurement approaches. Disabil Rehabil Assist Technol 2024; 19:2592-2601. [PMID: 38112328 DOI: 10.1080/17483107.2023.2294990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/29/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Assistive technology (AT) use is prevalent in older adulthood and can accommodate activity difficulties to support well-being. However, within the context of multiple activity difficulties and multiple technology use, it is unclear how to best assess their combined effects on older adults' health outcomes. This study proposed four distinct approaches to quantify multiple AT use and examined their respective impact in later life. MATERIAL AND METHODS Using data from the 2015 round of the National Health and Aging Trends Study (n = 6,936), we compared four indices to summarize the state of multiple AT use among the U.S. older population: binary, item-specific, cumulative, and accommodative. Separate regression analyses tested the impact of each index on older adults' well-being and restricted participation in meaningful activities. RESULTS In 2015, 59.9% of the respondents were identified as AT users. Among these users, 53.8% reported using two or more technologies when performing daily self-care and mobility activities. The implications of multiple AT use for health outcomes varied across the four indices. Approaches that captured elements of person-technology fit provided the most nuanced and actionable insights on the benefits of using AT to support well-being. CONCLUSIONS ATs were commonly adopted by older adults in everyday activities. Overall, findings suggest that there are multiple approaches to conceptualize the independent, cumulative, or balanced effects of multiple AT use. Each measurement approach has unique implications for understanding the impacts of using ATs on older adults' health outcomes.
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Affiliation(s)
- Tai-Te Su
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Shannon T Mejía
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
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Matsuda T, Muranaga S, Zeni JA, Yoshida Y. Simple Mobility Tests Predict Use of Assistive Devices in Older Adults. J Geriatr Phys Ther 2024; 47:175-182. [PMID: 38744441 DOI: 10.1519/jpt.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members. PURPOSE/OBJECTIVES The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals. METHODS Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use. RESULTS 80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers ( P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048). DISCUSSION Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD. CONCLUSIONS If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.
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Affiliation(s)
- Toru Matsuda
- Rehabilitation Administration Department, Kameda Medical Center, Kamogawa, Japan
| | - Shingo Muranaga
- Rehabilitation Administration Department, Kameda Medical Center, Kamogawa, Japan
| | - Joseph A Zeni
- Department of Rehabilitation and Movement Science, Rutgers the State University of New Jersey, Newark, New Jersey
| | - Yuri Yoshida
- Division of Physical Therapy at the University of New Mexico, Albuquerque, New Mexico
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Alizadeh Noghani M, Browning D, Caccese V, DePoy E, Gilson S, Beaumont R, Hejrati B. Design and evaluation of the Afari: A three-wheeled mobility and balance support device for outdoor exercise. Assist Technol 2024; 36:378-387. [PMID: 34495809 DOI: 10.1080/10400435.2021.1976885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 10/20/2022] Open
Abstract
This article presents the engineering design and preliminary testing of the AfariTM mobility device and the integrated IntracTM activity tracking system. The patented Afari design is a three-wheeled device that assists users of any age with mobility impairments with outdoor exercise and movement in various environments and surfaces. We devised methods for testing of the Afari to ensure safe and flexible mobility assistance and demonstrated a high level of stability and structural integrity suitable for vigorous outdoor exercise. A smartphone-based sensing system, the Intrac, was designed for and integrated with the Afari to monitor the user's interaction forces and important gait parameters. The Intrac offers a graphical user interface for displaying and sharing measurements with users and providers, and the accuracy of its measurements was validated by testing its individual components. A preliminary subject study showed that the participants could use the Afari for various levels of weight compensation during walking, while the Intrac enabled the measurement of interactive forces on their arms and key gait parameters. The results demonstrate the potential of the Afari and Intrac to provide a safe walking experience in a variety of terrains and continuously monitor users' gait.
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Affiliation(s)
| | - Drew Browning
- Department of Mechanical Engineering, University of Maine, Orono, Maine, USA
| | - Vincent Caccese
- Department of Mechanical Engineering, University of Maine, Orono, Maine, USA
| | - Elizabeth DePoy
- School of Social Work, University of Maine, Orono, Maine, USA
| | - Stephen Gilson
- School of Social Work, University of Maine, Orono, Maine, USA
| | | | - Babak Hejrati
- Biorobotics and Biomechanics Lab, University of Maine, Orono, Maine, USA
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Khalil MIM, Ashour A, Shaala RS, Mousa EFS, Sorour DM. Effect of a digital two-dimensional animation program on attitude toward walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities. Geriatr Nurs 2024; 60:32-41. [PMID: 39216215 DOI: 10.1016/j.gerinurse.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 07/16/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
The study investigated the impact of a two-dimensional animation program on attitudes towards walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities. A quasi-experimental pretest-posttest control group study was conducted on 128 older adults aged 60 years and above. The intervention group showed more favorable attitudes towards walking aids, improved cane and walker use, and reduced fall concerns. The 2D animation program proved to be an innovative teaching strategy that positively influenced attitudes, performance, and fall-related concerns among elderly residents. Integration into care settings could enhance mobility, reduce fall risks, and contribute to overall well-being.
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Affiliation(s)
| | - Ayat Ashour
- Lecturer of Public Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | - Reem Said Shaala
- Lecturer of Internal Medicine, Geriatric Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Enas Fouad Sayed Mousa
- Lecturer of Geriatric Medicine and Gerontology, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Dina Metwally Sorour
- Lecturer of Gerontological Nursing, Faculty of Nursing, Alexandria University, Egypt
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Clas H, Ehrnthaller C, Herrmann O, Schraeder DT, Böcker W, Manz K, Thaller P. Quality of Life and Patient Satisfaction After the Provision of an Orthopedic Knee Scooter—a Multicenter Randomized Controlled Trial. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024:arztebl.m2024.0121. [PMID: 38932517 DOI: 10.3238/arztebl.m2024.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND Partial or total avoidance of weight-bearing by a lower limb is regularly needed after trauma and surgery. There are approximately 200 such cases per 100 000 persons per year. Forearm crutches have mainly been used in Germany until now to keep these patients mobile. For those who lack the strength or coordination needed to use crutches, a wheelchair may become necessary, or they might find themselves forced to continue weight-bearing on the affected limb, with possible impending adverse consequences and complications. METHODS The supplementary use of a new type of orthopedic scooter by patients who must avoid weight-bearing by a lower limb, wholly or in part, was studied in a multicenter randomized controlled trial involving 88 subjects. The endpoints were improvement in quality of life (EQ5D, SF36) and improved abilities in everyday life (retrospective registration: DRKS00032980). RESULTS Patients who used orthopedic knee scooters (KS) reported a better overall state of health more frequently than those who used forearm crutches (UC) (SF-36 score: 67 [KS group], 95% CI [61; 73]; 59 [UC group], [53; 64]). They also reported less anxiety and depressed mood, greater mobility, and more independence than the patients who used crutches. In addition, they more frequently reported being able to transport themselves 4 x 500 meters in less than 20 minutes (n = 30 [KS], 63.8% [48.5; 77.3]; n = 6 [UC], 14.6% [5.6, 29.2]). CONCLUSION The supplementary use of an orthopedic knee scooter can improve these patients' mobility and independence and prolong the distance over which they can transport themselves. For many patients, this form of treatment may well shorten the time of their total or partial inability to work and thus lower the socioeconomic costs of lower limb injuries and surgery.
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Wang A, Gonzaga K. Assistive Devices for Addressing Mobility Impairments Linked to Cancer and Cancer Treatment: An Expert Perspective. Semin Oncol Nurs 2024; 40:151683. [PMID: 38965022 DOI: 10.1016/j.soncn.2024.151683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Cancer survivors often experience mobility impairments that negatively impact their ability to engage in everyday activities. Healthcare providers working with patients in the continuum of cancer care play essential roles in identifying and addressing mobility impairments. The objective of this article is to present common assistive devices valuable in managing cancer and cancer treatment-related mobility impairments. METHODS Peer-reviewed scientific publications and expert opinions. RESULTS This article highlights assistive devices commonly used in various settings of cancer care and describes how they address different impairments faced by cancer survivors. The information presented can potentially serve as a resource when training clinical staff (eg, oncology nursing staff) on device provision across all settings. The information can also be useful for patients and caregivers to learn about potential functional impairments linked to cancer and treatments and assistive devices that can be useful to improve patients' functional capacity and reduce caregiver burden. CONCLUSION It is essential to involve different team members to identify and select the most appropriate assistive devices that match the patient's functional needs and physical capacity and to train them in device use so they can safely carry out their daily routine. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are one of the first providers to identify mobility impairments in cancer patients. This article will help increase their knowledge in common assistive devices valuable for addressing various mobility impairments associated with cancer and treatments. With additional training on device provision, oncology nurses will be more empowered to collaborate with rehabilitation to identify potential mobility impairments, initiate device provision, and encourage their patients to work with therapy services. Ultimately this could reduce injuries linked to mobility impairments and improve the patient's functional independence and overall quality of life.
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Affiliation(s)
- Allison Wang
- Staff Physical Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York.
| | - Kimberley Gonzaga
- Senior Occupational Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York
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Obata H, Ogawa T, Kaneko N, Ishikawa K, Nakazawa K. Distinct locomotor adaptation between conventional walking and walking with a walker. Exp Brain Res 2024; 242:1861-1870. [PMID: 38856929 DOI: 10.1007/s00221-024-06863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
Rolling walkers are common walking aids for individuals with poor physical fitness or balance impairments. There is no doubt that rolling walkers are useful in assisting locomotion. On the other hand, it is arguable that walking with rolling walkers (WW) is effective for maintaining or restoring the nervous systems that are recruited during conventional walking (CW). This is because the differences and similarities of the neural control of these locomotion forms remain unknown. The purpose of the present study was to compare the neural control of WW and CW from the perspective of a split-belt adaptation paradigm and reveal how the adaptations that take place in WW and CW would affect each other. The anterior component of the ground reaction (braking) forces was measured during and after walking on a split-belt treadmill by 10 healthy subjects, and differences in the peak braking forces between the left and right sides were calculated as the index of the split-belt adaptation (the degree of asymmetry). The results demonstrated that (1) WW enabled subjects to respond to the split-belt condition immediately after its start as compared to CW; (2) the asymmetry movement pattern acquired by the split-belt adaptation in one gait mode (i.e., CW or WW) was less transferable to the other gait mode; (3) the asymmetry movement pattern acquired by the split-belt adaptation in CW was not completely washed out by subsequent execution in WW and vice versa. The results suggest unique control of WW and the specificity of neural control between WW and CW; use of the walkers is not necessarily appropriate as training for CW from the perspective of neural control.
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Affiliation(s)
- Hiroki Obata
- Department of Humanities and Social Sciences, Institute of Liberal Arts, Kyushu Institute of Technology, 1-1 Sensui-cho, Tobata-ku, Kitakyushu-shi, Fukuoka, 804-8550, Japan.
| | - Tetsuya Ogawa
- Department of Clothing, Faculty of Human Sciences and Design, Japan Women's University, 2-8-1 Mejirodai, Bunkyo-ku, Tokyo, 112-0015, Japan
| | - Naotsugu Kaneko
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
| | - Keiichi Ishikawa
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
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8
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Hwang D, Cho KH. Usability test for a cane-combined weight support feedback device. Technol Health Care 2024:THC240056. [PMID: 39031406 DOI: 10.3233/thc-240056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
BACKGROUND Traditional canes have no special functions besides weight support, and their long-term use may cause secondary damage to the musculoskeletal system and gait deviation. OBJECTIVE This study aimed to investigate the usability of the cane-combined weight support feedback device (CWSFD) to identify areas requiring improvement and the current level of satisfaction. METHODS As a collet-type device, the CWSFD has a structure allowing attachment and detachment at the lower end of a traditional mono cane. To assess the level of satisfaction and areas of improvement regarding the novel CWSFD, a usability test was conducted on 10 physical therapists with ⩾ 20 years of clinical experience. The usability test comprised a satisfaction survey questionnaire to determine the level of satisfaction, and an in-depth interview to identify the points of improvement. RESULTS The usability test demonstrated a moderate or higher level of satisfaction in all tested items, and the in-depth interview revealed that the device should have a lower weight with a greater diversity of feedback. CONCLUSIONS We anticipate that by implementing the respective improvements, a novel device will be developed in the future; for its commercialization, studies to verify the clinical effectiveness are warranted.
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Ezugwu UA, Eze BM, Ojide RN, Alegu DN, Ngwakwe PC, Elom NA, Ogah CI, Nwimo IO. Effect of ambulatory mobility aid devices on cardiovascular parameters, walking speed, perceived exertion, and balance of older adult men in Enugu, Nigeria. SAGE Open Med 2024; 12:20503121241262250. [PMID: 38911443 PMCID: PMC11193921 DOI: 10.1177/20503121241262250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Ambulatory mobility aids are several devices the elderly may use in order to improve their walking pattern, balance, or safety while mobilizing independently. Objectives To assess the effect of ambulatory mobility aid devices on cardiovascular parameters, walking speed, perceived exertion, and balance of older adult men. Methods A sample of 156 old men was studied. Data were obtained through measurement of the participants' walking speed (distance covered/second), cardiovascular parameters (blood pressure), perceived exertion (difficulty or ease in breathing), and balance (ease in standing) after walking with and without the selected walking aid devices. Analysis was done to compare the effect of the walking aid devices on the selected dependent variables. Results Results showed ambulation with mobility aid devices resulted in increase in the heart rate and blood pressure with the greatest increase observed when walking with Zimmer frame. Ambulation with mobility aid devices resulted in decrease of the walking speed of the participants when compared to ambulation without devices. Perceived exertion of participants after using Zimmer frame and walking cane was within 4.06 ± 1.35 and 3.98 ± 1.26, respectively, as opposed to 3.08 ± 0.73 after ambulation without aid. Use of Zimmer frame provided enough balance for participants. Conclusion Ambulatory mobility devices caused difference in cardiovascular parameters when compared to ambulation at rest and without aid. It was recommended that selection of ambulatory mobility aid devices should depend on objective mobility assessments and periodical re-evaluation to ensure that it suits a person's functional requirements and physical capabilities.
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Affiliation(s)
- Uchechukwu A Ezugwu
- Department of Medical Rehabilitation, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Barbra M Eze
- Department of Medical Rehabilitation, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Rita N Ojide
- Faculty of Health Sciences, Department of Public Health, Madonna University, Elele Campus, Elele, Rivers State, Nigeria
| | - Deborah N Alegu
- David Nweze Umahi University of Medical Sciences, Uburu, Ebonyi State, Nigeria
| | - Patricia C Ngwakwe
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Nwamaka A Elom
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Christian I Ogah
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Ignatius O Nwimo
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
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Maximo T, Fong KNK, Lau NML. Stigma and the use of umbrellas, hiking poles and walking sticks to aid walking in Hong Kong. Hong Kong J Occup Ther 2024; 37:52-60. [PMID: 38912102 PMCID: PMC11192428 DOI: 10.1177/15691861241254862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background The use of walking aids is widely acknowledged as one of the most relied-on forms of assistive technology. Using stick-shaped devices, such as a cane, is often the entrance for many people to the world of assistive technologies, often accompanied by the negative stigma associated with ageing and disability. Objectives This study investigated the perception of disability and needs of the Hong Kong population using walking aids, aiming to inform device design and service provision. Methods We observed 391 individuals using cane-like devices in their natural environment and conducted semi-structured interviews with 28 participants to understand stigma, barriers to acquisition, training, and design requirements. Results Half of the interviewees (50%, n = 14) did not feel disabled when using a walking stick, while 39% felt slightly disabled. 56% of the observed sample used non-medical-looking aids like hiking poles or umbrellas. Most interviewees (79%) purchased off-the-shelf devices, but less than half received seller support in choosing appropriate aids. Conclusion The feelings associated with using walking sticks and similar devices are mostly positive. There is a preference in Hong Kong for using devices without a medical appearance to aid walking, such as umbrellas and hiking poles. There is a need to raise awareness of the risks of using umbrellas to aid walking and empower the user to make informed decisions when purchasing walking aid devices. In addition, there is a need to support the supply chain of walking aids, including umbrellas and hiking poles, to provide more information on device use, misuse, training, and maintenance.
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Affiliation(s)
- Tulio Maximo
- The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Newman ML Lau
- The Hong Kong Polytechnic University, Hong Kong SAR, China
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Maron C, Jendre A, Goble D, Marks C, Haworth J. Acute Knee Crutch Use Provokes Changes to Postural Strategy. Percept Mot Skills 2024; 131:805-817. [PMID: 38613514 DOI: 10.1177/00315125241246390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Single-leg knee crutches are a relatively new, hands-free mobility assistive device with benefits over standard axillary crutches. Our main goal in this study was to evaluate balance ability in a healthy population upon first exposure to the knee crutch device. We had 20 healthy individuals (M age = 21.1; SD = 1.5 years) complete baseline static and dynamic balance tests on a force plate, followed by knee crutch fitting, a self-selected duration of ambulation practice, and another round of balance testing while wearing the knee crutch. We used the BTrackS Balance Test (BBT) to measure static balance, and the BTrackS Limits of Stability (BLOS) test to measure dynamic balance, and we created a custom lateral bias score from the BLOS results. On average, participants self-selected 3.1 minutes of ambulation practice. Wearing the knee crutch caused a near doubling of static balance path length and a large reduction in percentile ranking on the BBT. Dynamic balance area was more than halved (p < .001), with lateral bias scores during the BLOS, indicating that participants heavily favored their non-crutched leg (p < .001). Our results indicate that static and dynamic balance were significantly altered when wearing the knee crutch, and participants seemed to switch to a single leg stance strategy. Despite these balance changes, participants were quickly ready and willing to complete independent ambulation and balance testing procedures using the single-leg knee crutch.
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Affiliation(s)
- Christian Maron
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Aron Jendre
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Daniel Goble
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Charles Marks
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Joshua Haworth
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
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Pan H, Ng SSM, Liu TW, Lam SSL, Chan CCC, Li CSK, Chung RCK, Lai CWK, Ng WWL, Tang MWS, Hui E, Woo J. Self-perceived upper extremity motor function predicts health-related quality of life in chronic stroke survivors. Disabil Rehabil 2024:1-8. [PMID: 38711228 DOI: 10.1080/09638288.2024.2344652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To examine whether the Upper Extremity Functional Index (UEFI) score independently contributes to the Stroke Impact Scale (SIS) score and quantified its relative contribution to SIS scores in chronic stroke survivors. MATERIALS AND METHODS A cross-sectional study in a university-based rehabilitation centre with people with chronic stroke (N = 95) aged ≥ 50 years. The outcome measures included paretic hand grip strength, Fugl-Meyer Upper Extremity Assessment (FMA-UE), Wolf Motor Function Test (WMFT), UEFI, and SIS. RESULTS Correlation analysis revealed that paretic hand grip strength, FMA-UE, UEFI, and WMFT scores exhibited a significant moderate positive correlation with SIS scores (r = 0.544-0.687, p < 0.001). The results of a regression model indicated that after adjustment for demographic factors and stroke-related impairments, the UEFI scores remained independently associated with SIS scores, accounting for 18.8% of the variance. The entire model explained 60.3% of the variance in SIS scores. CONCLUSIONS Self-perceived UE motor function is a crucial component to be included in rehabilitation programmes aimed at enhancing quality of life and participation among chronic stroke survivors.
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Affiliation(s)
- Hong Pan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Tai Wa Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China (SAR)
| | - Stefanie S L Lam
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Charles C C Chan
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Carol S K Li
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Charles W K Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Winnie W L Ng
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China (SAR)
| | - Maria W S Tang
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China (SAR)
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China (SAR)
| | - Jean Woo
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (SAR)
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Nickerson KA, Diaz K, Muir BC. Circumstances of falls among older adult walker users in long-term care and the associated walker design deficits. Assist Technol 2024; 36:248-253. [PMID: 37796449 PMCID: PMC10995100 DOI: 10.1080/10400435.2023.2267623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
Falls are the leading cause of fatal and non-fatal injuries in older adults. Walkers are often used by and prescribed to this population to reduce fall risk, however, walker users and walker non-users alike experience similar fall incidence rates. The role of walkers in preventing falls is unclear as some studies suggest walkers may be a fall-inciting factor. The purpose of this study was to analyze walker deficits by evaluating the circumstances and causes of falls in older adult walker users residing in long-term care facilities. Videos capturing 34 real-life falls involving wheeled walkers (rollators and two-wheeled walkers) in two retirement facilities were analyzed for 3 themes: walker type, fall direction, and activity at the time of fall. A frequency analysis of these themes was performed to determine common fall mechanisms. The results of this study suggest two-wheeled walker and rollator users most often fall sideways while turning and backward during weight transfer, respectively. Poor maneuverability, lateral stability, and wheel velocity control of the walkers contributed to the falls. Device improvements addressing these areas of deficiency may be necessary to mitigate falls occurring in older adult walker users.
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Affiliation(s)
- Kimberly A. Nickerson
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
- Department of Veterans Affairs Puget Sound, VA RR&D Center for Limb Loss and MoBility (CLiMb), Seattle, Washington, USA
| | - Kailey Diaz
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
- Department of Veterans Affairs Puget Sound, VA RR&D Center for Limb Loss and MoBility (CLiMb), Seattle, Washington, USA
| | - Brittney C. Muir
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
- Department of Veterans Affairs Puget Sound, VA RR&D Center for Limb Loss and MoBility (CLiMb), Seattle, Washington, USA
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14
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Usman JS, Salisu R, Abdullahi A, Salihu AT, Muhammad AH, Sulaiman SK, Yakasai AM. Assistive Technology utilization among stroke survivors in Kano, Northwest Nigeria: A cross-sectional study. Assist Technol 2024; 36:209-216. [PMID: 37699108 DOI: 10.1080/10400435.2023.2244560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/14/2023] Open
Abstract
Mobility impairments and participation restrictions are common occurrences post-stroke, which may necessitate the need to utilize Assistive Technology (AT). This study investigated the prevalence, pattern, and satisfaction with AT utilization in stroke survivors (SS). The study was conducted in two hospitals in Kano, Nigeria. The QUBEC user evaluation of satisfaction with AT (QUEST) questionnaire and the Rivermead Mobility Index were used to assess satisfaction with AT utilization and mobility, respectively. Pearson correlation and independent t-test were used to determine the relationship and gender difference among the outcomes, respectively. A total of 280 SS participated; however, only 115 (41.07%) were AT users. The commonly used AT was wheelchair 84 (73%), while the least used was walking frame 3 (2.6%). About two-thirds of the participants were quite or very satisfied with their ATs. The duration of AT utilization is positively related to stroke duration (r = 0.940) but negatively related to mobility level (r = -0.246). There is no significant gender difference in duration and satisfaction with AT utilization. AT like wheelchairs seems uncommonly utilized among SS in Kano, Nigeria, likely due to patients' lack of knowledge of use, economic factors, and culture among others.
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Affiliation(s)
- Jibrin Sammani Usman
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Rabbilu Salisu
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Auwal Abdullahi
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ashiru Hamza Muhammad
- Department of Public Health, Godiya Disability Inclusion and Development Initiative, Dutse, Jigawa, Nigeria
| | - Surajo Kamilu Sulaiman
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
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15
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Menz HB, Bergin SM, McClelland JA, Munteanu SE. Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data. Gerontology 2024; 70:611-619. [PMID: 38626742 DOI: 10.1159/000538731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/31/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate. METHODS Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and fall characteristics (proposed mechanism and fall direction). RESULTS There were 300 falls experienced by 118 older adults aged 58 years-98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%), and wearing shoes (7/99 falls, 7%). CONCLUSION Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.
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Affiliation(s)
- Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shan M Bergin
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jodie A McClelland
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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16
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Raitor M, Ruggles SW, Delp SL, Liu CK, Collins SH. Lower-Limb Exoskeletons Appeal to Both Clinicians and Older Adults, Especially for Fall Prevention and Joint Pain Reduction. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1577-1585. [PMID: 38536680 DOI: 10.1109/tnsre.2024.3381979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Exoskeletons are a burgeoning technology with many possible applications to improve human life; focusing the effort of exoskeleton research and development on the most important features is essential for facilitating adoption and maximizing positive societal impact. To identify important focus areas for exoskeleton research and development, we conducted a survey with 154 potential users (older adults) and another survey with 152 clinicians. The surveys were conducted online and to ensure a consistent concept of an exoskeleton across respondents, an image of a hip exoskeleton was shown during exoskeleton-related prompts. The survey responses indicate that both older adults and clinicians are open to using exoskeletons, fall prevention and joint pain reduction are especially important features, and users are likely to wear an exoskeleton in the scenarios when it has the greatest opportunity to help prevent a fall. These findings can help inform future exoskeleton research and guide the development of devices that are accepted, used, and provide meaningful benefit to users.
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17
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Hinton EH, Bierner S, Reisman DS, Likens A, Knarr BA. Paretic propulsion changes with handrail Use in individuals post-stroke. Heliyon 2024; 10:e26924. [PMID: 38463863 PMCID: PMC10920377 DOI: 10.1016/j.heliyon.2024.e26924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
Background Roughly 800,000 people experience a stroke every year in the United States, and about 30% of people require walking assistance (walker, cane, etc.) after a stroke. Gait training on a treadmill is a common rehabilitation activity for individuals post-stroke and handrails are typically used to assist with walking during this training, however individual interaction with these handrails are not usually considered and quantitatively reported. Individuals may exert force onto the handrails to aid with propulsive force, but the relationship between limb propulsive force and handrail propulsive force are not known. Research question How do individuals post-stroke alter paretic propulsive force when using an assistive device, such as handrails on a treadmill? Methods Twenty-one individuals post-stroke (eight current assistive device users and thirteen individuals who do not use an assistive device) walked on a treadmill for 3 min during three conditions: no handrail use, light handrail use (<5% BW) and self-selected handrail use. Three multilevel models were used to compare percent handrail, paretic and nonparetic propulsion between handrail conditions and assistive device groups. Results The handrail propulsive impulse was more during the self-selected handrail condition compared to the light handrail condition (p = 0.002). The assistive device use group and the handrail condition fixed effects significantly improved the model fit for paretic propulsive impulse (p = 0.01). The interaction between assistive device use group and handrail condition significantly improved the model fit for nonparetic propulsive impulse (p < 0.001). Significance These results suggest that handrail use may impact paretic propulsive impulse. Our initial results suggest that if the goal of rehabilitation treadmill training is to increase the paretic propulsive impulse, having the clinician encourage walking with the handrails may be optimal to promote paretic propulsion.
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18
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Wiederien RC, Gari WJ, Wilken JM. Effect of crutch and walking-boot use on whole-body angular momentum during gait. Assist Technol 2024; 36:164-172. [PMID: 37499144 PMCID: PMC10818012 DOI: 10.1080/10400435.2023.2229879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
Crutches are the most prescribed ambulatory assistive device and are used for mobility and maintaining weight-bearing restrictions after injury or surgery. However, standard axillary crutches (SACs) can lead to overuse and other injuries and restrict upper limb movement. Hands-free crutches (HFC) do not restrict upper limb movement but their effect on balance control, with or without commonly prescribed walking boots, is poorly understood. The purpose of this study was to compare the effect of crutch type (SACs vs. HFC) and boot use on whole-body angular momentum (RAM), a measure of balance control. Participant's balance confidence, pain, comfort, and device preference were assessed. Seventeen participants were evaluated while walking without a crutch (NONE), with SACs, and with an HFC, and walked with and without a walking boot in each crutch condition. The gait pattern used with SACs resulted in significantly greater limb angular velocity (p < .05), and an 84% increase in RAM (p < .001) as compared to the HFC. There were no differences between the SAC and HFC for balance confidence, pain, or comfort, however most (71.1%) participants preferred the HFCs. These results suggest that individuals can better control angular momentum with the HFCs and thus may be less susceptible to loss of balance.
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Affiliation(s)
- Robert C. Wiederien
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Wesley J. Gari
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jason M. Wilken
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Hegeman EM, Huh J. Lower Extremity Assistive Devices (LEADs): A Contemporary Literature Review. Foot Ankle Int 2024; 45:192-201. [PMID: 37950340 DOI: 10.1177/10711007231207637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Lower extremity ambulatory assistive devices (LEADs) are important augments that provide mobility and stability when weightbearing is restricted in the setting of injury, surgery, or balance disorders. In order to optimize patient safety and function when prescribing these devices, it is essential for the orthopaedic surgeon to have a firm understanding of their specific indications, proper fitting, energy demand, biomechanical advantages, and potential complications. Comprehension of normal gait cadence, identification of the functional deficit present and knowledge of available options will assist in safely prescribing the proper device. Over the last decade, newer alternatives to traditional LEADs (canes, crutches, walkers) have become available, including the rolling knee scooter and hands-free single crutch. These have been developed to improve mobility and independence; however, it is necessary to appreciate their limitations when prescribing them to patients. This review will provide an update on normal and pathologic gait biomechanics as well as the most common types of LEADs currently available to the orthopaedic surgeon, their indications, important considerations, proper fitting, associated energy expenditure, and complications.
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Affiliation(s)
- Erik M Hegeman
- Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Jeannie Huh
- Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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20
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Takeda R, Miyata K, Tamura S, Kobayashi S, Iwamoto H. Item distribution of the Berg Balance Scale in older adults with Hip fracture: a Rasch analysis. Physiother Theory Pract 2024; 40:136-143. [PMID: 35930439 DOI: 10.1080/09593985.2022.2109541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/31/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Balance impairment occurs after a hip fracture, but the characteristics of the impairment are not clear. OBJECTIVE To investigate the uni-dimensionality, fit statistics, and item difficulty of the Berg Balance Scale (BBS) in older adults with hip fracture by conducting a Rasch analysis. METHODS This was an observational cross-sectional study. The 254 participants were all ≥ 65 years old and had been hospitalized for rehabilitation after a unilateral hip fracture incurred during a fall. We collected their BBS scores at the time of hospital discharge and conducted a Rasch analysis to examine the uni-dimensionality, fit statistics, and item difficulty. RESULTS The principal component analysis (PCA) of the Rasch model demonstrated that the BBS is uni-dimensional. The information-weighted mean square (MnSq) fit statistic was within the range of fit criteria for all items. The underfit item of the outlier-sensitive MnSq fit statistics was "Standing unsupported eyes closed" with the MnSq of 2.06. The difficult items were in order of logits: "Standing on one leg" (logits = 4.01); "Step tool" (logits = 2.74); and "Turn 360°" (logits = 2.61). CONCLUSION The BBS is uni-dimensional and conforms with the Rasch model. The BBS most difficult items for older adults with a hip fracture required one-legged support and dynamic balance.
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Affiliation(s)
- Ren Takeda
- Department of Rehabilitation, Numata Neurosurgery and Heart Disease Hospital, Numata, Japan
- Department of basic rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Sota Kobayashi
- Department of basic rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
- Department of Rehabilitation, Public Nanokaichi Hospital, Tomioka, Japan
| | - Hiroki Iwamoto
- Department of Rehabilitation, Hidaka Rehabilitation Hospital, Takasaski, Japan
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21
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Stevens PM, Hafner BJ, Weber EL, Morgan SJ, Bamer AM, Salem R, Balkman GS. Utilization of orthoses and assistive devices among a national sample of lower limb orthosis users. J Rehabil Assist Technol Eng 2024; 11:20556683241260891. [PMID: 39081391 PMCID: PMC11287728 DOI: 10.1177/20556683241260891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/26/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Lower limb orthoses (LLOs) and assistive devices (ADs) can be used together or separately to improve mobility when performing daily activities. The goal of this study was to examine utilization of LLOs and ADs in a national sample of adult LLO users. Methods A survey was designed to ask participants whether they typically use their LLOs and/or ADs to perform 20 daily activities. LLO users from orthotic clinics across the United States were invited to complete the survey. Descriptive statistics were used to examine utilization trends. Results Survey responses from 1036 LLO users were analyzed. Community-based activities were performed with LLOs by at least 80% of participants. Activities that involved walking short distances in the home were more often performed without LLOs or ADs. Among participants with the four most prevalent health conditions, LLO use in the community was greatest among participants with Charcot-Marie-Tooth disease. Conclusions LLOs were frequently used for a wide range of community-based activities. Simultaneous use of ADs and LLOs may be most beneficial for LLO users when performing activities outside of the home. Clinicians can discuss LLO and AD use with patients to optimize their functional outcomes at home and in the community.
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Affiliation(s)
- Phillip M Stevens
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Eric L Weber
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
| | - Sara J Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Gillette Children’s Specialty Healthcare, St Paul, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Geoffrey S Balkman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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22
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Manocha RHK, Best KL, Charette C, Curlock H, Sigfusson M, Faure C, Miller WC, Routhier F. Walking aid training as a clinical competence in Canadian entry-to-practice professional academic programs. Disabil Rehabil Assist Technol 2024; 19:112-119. [PMID: 35510304 DOI: 10.1080/17483107.2022.2070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Multiple healthcare professionals fit walking aids (WA) and train individuals on their use. The purpose of this investigation was to describe curricula on WA fitting and training in Canadian entry-to-practice professional programs. MATERIALS AND METHODS An online survey was administered to leads from all accredited programs (n = 199). Seventeen questions asked about the importance of WA education, instructional methods and time dedicated to WA fitting and skills training, and how the pandemic had affected WA curriculum delivery. RESULTS Responses were received from 97 programs. While most occupational therapy (OT, 8/15), physiatry (PM&R, 5/9), and physical therapy (PT, 12/19) trainees received more than 3 h of instruction on WA fitting, most nursing (29/40) and pharmacy (7/8) programs spent less than 3 h on this topic. Most OT (9/15) and PT (15/19) programs spent more than 3 h on WA skills training whereas most nursing (25/40), pharmacy (4/8), and PM&R (5/9) programs spent less than 3 h on this subject. Across all programs, 52% educated students on adapting activities of daily living for WA while 18% provided education on WA maintenance and repair. Only 19/89 programs consulted a formal WA skills training resource for curriculum development. Seventeen of 55 programs modified their WA curricula due to the pandemic. CONCLUSIONS There is a wide range in curricular approaches to WA education in Canadian professional programs. This highlights the need for a standardised WA education program to guide curricular development to ultimately improve safe WA use for clients with short- and long-term mobility impairments.IMPLICATIONS FOR REHABILITATIONCurricula on walking aids is extremely variable within and between programs.Navigating terrains, adapting activities of daily living, and maintenance are poorly taught.There is a need for a national standardized curriculum on walking aids.This curriculum should be modular and designed for practitioners, students, and patients.
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Affiliation(s)
- Ranita H K Manocha
- Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Krista L Best
- Département de réadaptation, Faculté de médecine, Université Laval, Laval, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Caroline Charette
- Département de réadaptation, Faculté de médecine, Université Laval, Laval, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Hannah Curlock
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Merissa Sigfusson
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Céline Faure
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - François Routhier
- Département de réadaptation, Faculté de médecine, Université Laval, Laval, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
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23
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Hill KD, Meyer C, Burton E, Hunter SW, Suttanon P, Dawes H, Lee DCA. Examining gait aid use and user safety by older people with dementia: Perspectives of informal carers to inform practice. Disabil Rehabil 2023; 45:4279-4287. [PMID: 36444878 DOI: 10.1080/09638288.2022.2148302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine gait aid use and decision-making related to usage in people with dementia, and examine factors influencing (1) gait aid use or not; and (2) falls in past year. MATERIALS AND METHODS A survey of informal carers of older people with dementia in the community. Closed questions on gait aid use, falls, timing and sources of gait aid acquisition, and advice received to support use were used. Chi-squared tests (Fisher's Exact) compared: (1) gait aid users vs non-users and carers' report of (i) unsteadiness in walking/turning, (ii) dementia severity, (iii) falls in past year, and (2) fallers vs non-fallers and (i) timing of gait aid commencement relative to dementia diagnosis, (ii) whether health professional advice was received regarding use, and iii) regularity of use. RESULTS Forty-seven completed surveys, 63.8% of care recipients used a gait aid; 56.9% had ≥2 falls in past year; 66.7% commenced use after dementia diagnosis; 25% acquired their aids from non-health professionals; and 37% did not receive advice regarding use. Gait aid users and non-users differed on carer ratings of unsteadiness in walking/turning (p = 0.02). CONCLUSION Carers reported important aspects regarding gait aid acquisition, safe gait aid use and benefits which warrant further investigation.IMPLICATIONS FOR REHABILITATIONIn our small sample, use of gait aids by people with dementia was related to the level of unsteadiness in walking and/or turning, and not associated with falling in the past year.People with dementia do not routinely receive professional advice about how to use gait aids, highlighting the potential value of maximizing health professional involvement in gait aid prescription and training.Deterioration in the ability of gait aid use after the diagnosis of dementia indicates a need for re-assessment or re-training of gait aid use over time.Clinical guidelines to facilitate decision-making regarding under what conditions gait aids are beneficial, what duration and aspects require instruction to ensure effective use by people with dementia are needed.
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Affiliation(s)
- Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- Bolton Clarke Research Institute, Brisbane, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Plaiwan Suttanon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Helen Dawes
- Intersect@Exeter, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Den-Ching A Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
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24
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Amatachaya S, Nithiatthawanon T, Amatachaya P, Thaweewannakij T. Effects of four-week lower limb loading training with and without augmented feedback on mobility, walking device use, and falls among ambulatory individuals with spinal cord injury: a randomized controlled trial. Disabil Rehabil 2023; 45:4431-4439. [PMID: 36472135 DOI: 10.1080/09638288.2022.2152502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the effects of lower limb loading training (LLLT) with or without augmented loading feedback during stepping activity on mobility, walking device use, and falls among ambulatory individuals with chronic spinal cord injury (SCI). STUDY DESIGN Randomized controlled trial (assessor-blinded) with prospective fall data follow-up, clinical trial registration (NCT03254797). METHODS Forty-four ambulatory participants (22 participants/group) were prospectively monitored for their baseline fall data over six months, with baseline assessments for their mobility and walking device used after six months. Then participants involved in the LLLT programs with or without loading feedback according to their groups for 30 min/day, 5 days/week, over 4 weeks. Mobility outcomes were re-assessed at week two and week four, with prospective fall data monitoring over six months, and mobility measured thereafter. RESULTS Mobility outcomes of the participants were significantly improved from their baseline ability, especially in those who were trained using augmented feedback (the difference in main outcome, timed up and go, between the groups was 1.8 s; 95% confidence interval = 1.0-3.5s). CONCLUSIONS LLLT during stepping activity, especially with augmented loading feedback, could be applied effectively to promote mobility and safety of ambulatory individuals with chronic SCI (post-injury time of approximately four years).
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Affiliation(s)
- Sugalya Amatachaya
- Faculty of Associated Medical Sciences, School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Teerawat Nithiatthawanon
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Physical Therapy, Division of Physical Therapy, Srinakharinwirot University (Ongkharak Campus), Nakhon-Nayok, Thailand
| | - Pipatana Amatachaya
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Thiwabhorn Thaweewannakij
- Faculty of Associated Medical Sciences, School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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25
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Yang J, Mo Z, Zhang Y, Ji R, Tao C, Fan Y. The effects of walking aids on shoulder joint kinematics in older persons: an initial study. BMC Geriatr 2023; 23:743. [PMID: 37964210 PMCID: PMC10648336 DOI: 10.1186/s12877-023-04439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Many older persons with degenerative physical functions use walking aids to improve their ambulation ability. The aim of this study was to investigate the effects of walking aids with different configurations on shoulder joint motion in older persons. METHODS The 3D motion capture system VICON was applied to collect data on gait parameters and shoulder motion characteristics of 6 older persons walking either independently or with the assistance of a footed walking frame and a wheeled walking frame. The different effects of walking aids on gait parameters and the shoulder joint motion of older individuals were quantitatively analyzed. RESULTS The gait parameters of the older individuals changed significantly when they used walking frames to assist walking. Compared to independent walking, the range of motion of the shoulder joint was reduced by 79.92% in flexion when walking with a wheeled walking frame. Meanwhile, the range of motion in flexion, extension, and external rotation increased by 76.04%, 85.55%, and 110.99%, respectively, when walking with a footed walking frame. CONCLUSION The motion characteristics of shoulder joints in older persons were significantly affected by using different walking aids. These changes in shoulder joint motion characteristics will lead to potential diseases related to the shoulder musculoskeletal system. These findings are beneficial to determine a walking aid for older people.
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Affiliation(s)
- Jiemeng Yang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Zhongjun Mo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Yanyu Zhang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Run Ji
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Chunjing Tao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China.
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China.
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Thies SB, Bevan S, Wassall M, Shajan BK, Chowalloor L, Kenney L, Howard D. Evaluation of a novel biomechanics-informed walking frame, developed through a Knowledge Transfer Partnership between biomechanists and design engineers. BMC Geriatr 2023; 23:734. [PMID: 37957568 PMCID: PMC10642022 DOI: 10.1186/s12877-023-04443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Walking aids such as walking frames offer support during walking, yet paradoxically, people who self-report using them remain more likely to fall than people who do not. Lifting of walking frames when crossing door thresholds or when turning has shown to reduce stability, and certain design features drive the need to lift (e.g. small, non-swivelling wheels at the front). To overcome shortfalls in design and provide better stability, biomechanists and industrial engineers engaged in a Knowledge Transfer Partnership to develop a novel walking frame that reduces the need for lifting during everyday tasks. This paper presents the results for the final prototype regarding stability, safety and other aspects of usability. METHODS Four studies were conducted that explored the prototype in relation to the current standard frame: a detailed gait lab study of 9 healthy older adults performing repeated trials for a range of everyday tasks provided mechanical measures of stability, a real-world study that involved 9 users of walking frames provided measures of body weight transfer and lifting events, two interview studies (5 healthcare professionals and 7 users of walking frames) elicited stakeholder perceptions regarding stability, safety and usability. RESULTS Analysis of healthy older adults using a standard walking frame and the prototype frame demonstrated that the prototype increases stability during performance of complex everyday tasks (p < 0.05). Similarly, gait assessments of walking frame users in their home environment showed that the prototype facilitated safer usage patterns and provided greater and more continuous body weight support. Interviews with healthcare professionals and users showed that the prototype was perceived to be safe and effective and hence more usable. CONCLUSIONS The outcomes of the separate studies all support the same conclusion: the prototype is an improvement on the status quo, the typical front-wheeled Zimmer frame for indoor use which has not changed in design for decades. The significance of this work lies in the success of the Knowledge Transfer Partnership and in biomechanics-informed design leading to improvements, which in future may be applied to other walking aids, to benefit walking aid users by promoting safer, more stable use of their aid.
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Affiliation(s)
- Sibylle Brunhilde Thies
- Centre for Health Sciences Research, School of Health & Society, University of Salford, Brian Blatchford Building Room PO28, Salford, Greater Manchester, UK.
| | - Susan Bevan
- NRS Healthcare, Coalville, LE67 1UB, Leicestershire, UK
| | - Matthew Wassall
- Centre for Health Sciences Research, School of Health & Society, University of Salford, Brian Blatchford Building Room PO28, Salford, Greater Manchester, UK
| | - Blessy Kurissinkal Shajan
- Centre for Health Sciences Research, School of Health & Society, University of Salford, Brian Blatchford Building Room PO28, Salford, Greater Manchester, UK
| | - Lydia Chowalloor
- Centre for Health Sciences Research, School of Health & Society, University of Salford, Brian Blatchford Building Room PO28, Salford, Greater Manchester, UK
| | - Laurence Kenney
- Centre for Health Sciences Research, School of Health & Society, University of Salford, Brian Blatchford Building Room PO28, Salford, Greater Manchester, UK
| | - Dave Howard
- Centre for Health Sciences Research, School of Health & Society, University of Salford, Brian Blatchford Building Room PO28, Salford, Greater Manchester, UK
- School of Science, Engineering and Environment, University of Salford, Salford, Greater Manchester, UK
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Thomson S, Cornish BF, Pun A, McIlroy WE, Van Ooteghem K. Advances in mobility aid use reporting: situational context and objective measurement improve understanding of daily aid use in older adults. Aging Clin Exp Res 2023; 35:2543-2553. [PMID: 37907663 DOI: 10.1007/s40520-023-02533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/08/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Understanding mobility aid use has implications for falls risk reduction and aid prescription. However, aid use in daily life is understudied and more complex than revealed by commonly used yes/no self-reporting. AIMS To advance approaches for evaluating mobility aid use among older adults using a situational (context-driven) questionnaire and wearable sensors. METHODS Data from two cross-sectional observational studies of older adults were used: (1) 190 participants (86 ± 5 years) completed tests of standing, sit-to-stand, walking, grip strength, and self-reported fear of falling and (2) 20 participants (90 ± 4 years) wore two body-worn and one aid-mounted sensors continuously for seven days to objectively quantify aid use during walking. Situational and traditional binary reporting stratified participants into aid dependency levels (0-4) and aid-user groups, respectively. Physical performance and fear of falling were compared between aid users, and dependency levels and sensor-derived walking behaviors were compared to reported aid use. RESULTS Physical performance and fear of falling differed between aid-user groups (P < 0.05). Sensor-derived outputs revealed differences in walking behaviors and aid use when categorized by dependency level and walking bout length (P < 0.05). Walking bout frequency (rho(18) = - 0.47, P = 0.038) and aid use time (rho(13) = .72, P = 0.002) were associated with dependency level. DISCUSSION Comparisons of situational aid dependency revealed heterogeneity between aid users suggesting binary aid use reporting fails to identify individual differences in walking and aid use behaviors. CONCLUSIONS Enhanced subjective aid use reporting and objective measurements of walking and aid use may improve aid prescription and inform intervention to support safe and effective mobility in older adults.
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Affiliation(s)
- Sherri Thomson
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Benjamin F Cornish
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Anthony Pun
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - William E McIlroy
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Karen Van Ooteghem
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Olsson Möller U, Zingmark M, Ekstrand J, Haak M. The Content of Physiotherapy and Factors Impacting on Reablement - A National Study. J Multidiscip Healthc 2023; 16:3075-3088. [PMID: 37881528 PMCID: PMC10596052 DOI: 10.2147/jmdh.s415112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions' actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95-4.49). About 50% (n=517) of the cases involved 1-2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients' needs and wishes, or conversely an expression of limited resources, remains to be investigated.
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Affiliation(s)
- Ulrika Olsson Möller
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Zingmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden
- Department of Community Medicine and Rehabilitation, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Joakim Ekstrand
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Maria Haak
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Herzog M, Krafft FC, Stetter BJ, d'Avella A, Sloot LH, Stein T. Rollator usage lets young individuals switch movement strategies in sit-to-stand and stand-to-sit tasks. Sci Rep 2023; 13:16901. [PMID: 37803010 PMCID: PMC10558536 DOI: 10.1038/s41598-023-43401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
The transitions between sitting and standing have a high physical and coordination demand, frequently causing falls in older individuals. Rollators, or four-wheeled walkers, are often prescribed to reduce lower-limb load and to improve balance but have been found a fall risk. This study investigated how rollator support affects sit-to-stand and stand-to-sit movements. Twenty young participants stood up and sat down under three handle support conditions (unassisted, light touch, and full support). As increasing task demands may affect coordination, a challenging floor condition (balance pads) was included. Full-body kinematics and ground reaction forces were recorded, reduced in dimensionality by principal component analyses, and clustered by k-means into movement strategies. Rollator support caused the participants to switch strategies, especially when their balance was challenged, but did not lead to support-specific strategies, i.e., clusters that only comprise light touch or full support trials. Three strategies for sit-to-stand were found: forward leaning, hybrid, and vertical rise; two in the challenging condition (exaggerated forward and forward leaning). For stand-to-sit, three strategies were found: backward lowering, hybrid, and vertical lowering; two in the challenging condition (exaggerated forward and forward leaning). Hence, young individuals adjust their strategy selection to different conditions. Future studies may apply this methodology to older individuals to recommend safe strategies and ultimately reduce falls.
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Affiliation(s)
- Michael Herzog
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte Ring 15, 76131, Karlsruhe, Germany.
- HEiKA-Heidelberg Karlsruhe Strategic Partnership, Heidelberg University, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Frieder C Krafft
- HEiKA-Heidelberg Karlsruhe Strategic Partnership, Heidelberg University, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Optimization, Robotics, and Biomechanics, Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
- Center of Prevention, Diagnostic and Performance, Center of Orthopaedics Hohenlohe, Künzelsau, Germany
| | - Bernd J Stetter
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte Ring 15, 76131, Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andrea d'Avella
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Università di Messina, Messina, Italy
| | - Lizeth H Sloot
- HEiKA-Heidelberg Karlsruhe Strategic Partnership, Heidelberg University, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Optimization, Robotics, and Biomechanics, Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte Ring 15, 76131, Karlsruhe, Germany
- HEiKA-Heidelberg Karlsruhe Strategic Partnership, Heidelberg University, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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30
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Park CS, Oh GB, Cho KH. Effects of gait training with weight support feedback walker on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete spinal cord injury: A pilot randomized controlled trial. J Spinal Cord Med 2023:1-9. [PMID: 37769143 DOI: 10.1080/10790268.2023.2260532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a devastating condition affecting an individual's life, particularly through lower extremity paralysis, which limits walking and daily activities. OBJECTIVES This study investigated the effects of weight support feedback walker (WSFW) gait training on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete SCI (ISCI). METHODS Eleven subjects capable of walking > 20 m with and without a walker were randomly assigned to WSFW gait training (n = 6) or conventional walker (CW) gait training groups (n = 5). All subjects underwent standard physical therapy for 4 weeks. Additionally, the WSFW group participated in WSFW gait training, whereas the CW group participated in CW gait training conducted for 30 min per day, thrice per week, for 4 weeks. Walker dependence (the average force pressing WSFW with the user's arm during walker gait), lower extremity muscle activity (rectus femoris, biceps femoris, and medial gastrocnemius), and gait ability (gait elements: velocity, cadence, step length, and step length asymmetry) were measured to investigate the effects of training. RESULTS The WSFW group showed significant decrease in walker dependence compared to the CW group (P < 0.05). Some lower extremity muscle activation (left side biceps femoris) and velocity of the gait elements were increased in the WSFW group compared with those in the CW group (P < 0.05). CONCLUSION WSFW gait training could help patients with ISCI transfer their body weight to the paralyzed lower extremity. However, a randomized controlled trial with several subjects is essential to verify the effects of WSFW training.
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Affiliation(s)
- Chang Sune Park
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Gku Bin Oh
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Ki Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
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31
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Walsh JP, Hsiao MS, Rosevear L, McDermott R, Gupta S, Watson TS. Orthopaedic knee scooter-related injury: prevalence and patient safety perception in a prospective cohort with exploratory risk factor analysis. J Orthop Surg Res 2023; 18:649. [PMID: 37658457 PMCID: PMC10474665 DOI: 10.1186/s13018-023-04124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND There is a paucity of research investigating the harms associated with orthopaedic knee scooter (OKS) use and patient safety perceptions. This prospective study aimed to define the prevalence of OKS-related injuries, describe the patient perceptions of OKS safety, and identify potential risk factors. METHODS This study was conducted at a single foot and ankle fellowship-trained surgeon's community-based clinic from 6/2020 to 4/2021 and enrolled 134 patients. Our primary outcome was an OKS-related event (injury or fall) and informed an a priori power analysis. Point estimate of association magnitude was calculated as an odds ratio (OR) for statistically and clinically significant associations. RESULTS There were 118 (88%) patients eligible for analysis; fourteen enrolled patients did not use OKS, and two withdrew. The prevalence of patient falls was 37% (44/118), and the prevalence of patient injury was 15% (18/118). Four percent of patients would not recommend OKS and 8% would not use an OKS again. Sedentary lifestyle increased risk (OR = 4.67, 1.52-14.35 95 CI) for OKS-related injury. CONCLUSIONS Despite a high prevalence of patient falls (37%), there is a low prevalence of injury (15%) and a favorable perception of OKS safety. Sedentary lifestyles may be a risk factor for OKS-related injury and should be considered in the development of a risk model.
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Affiliation(s)
- John P Walsh
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, 620 Shadow Lane, Suite 450, Las Vegas, NV, 89121, USA.
- The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA.
| | - Mark S Hsiao
- The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Landon Rosevear
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, 620 Shadow Lane, Suite 450, Las Vegas, NV, 89121, USA
| | - Ryland McDermott
- The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Shivali Gupta
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, 620 Shadow Lane, Suite 450, Las Vegas, NV, 89121, USA
| | - Troy S Watson
- Department of Orthopaedic Surgery, Valley Hospital Medical Center, 620 Shadow Lane, Suite 450, Las Vegas, NV, 89121, USA
- The Foot and Ankle Institute at Desert Orthopaedic Center, Las Vegas, NV, USA
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Oh GB, Park CS, Cho KH. Immediate effect of weight load on lower limb muscle activity and gait ability in patients with incomplete spinal cord injury during walker gait training. J Spinal Cord Med 2023; 46:818-824. [PMID: 35792819 PMCID: PMC10446802 DOI: 10.1080/10790268.2022.2088502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Walkers are actively used to improve gait ability in patients with incomplete spinal cord injury (ISCI). This study aimed to investigate the immediate effect of weight load during walker gait training on lower limb muscle activity and gait ability in patients with ISCI using a dependence feedback walker (DFW). DESIGN A single group cross-sectional design. SETTING Local rehabilitation hospital. PARTICIPANTS Fourteen patients with ISCI (62.00 years, Onset duration: 20.57months). INTERVENTIONS The DFW was used to measure the change in lower limb muscle activity and gait ability on walker dependence during the 20-meter walk. Based on the initial measurement of walker dependence, three levels of walker dependence threshold were set (100%, 60%, and 20%). If the weight loaded on the walker exceeded the three threshold levels of walker dependence, auditory and visual feedback was generated. OUTCOME MEASURES During the 20-meter walk, changes in both lower limb muscle activity (rectus femoris, biceps femoris, medial gastrocnemius, tibialis anterior, and gluteus medius) and gait ability (velocity, cadence, and single-limb support phase) were measured by surface electromyography and 3-axis accelerometer. RESULTS The increase in lower limb muscle activation and improvement of gait ability were greater during 20% walker dependence gait training than during 100% walker dependence gait training (P < 0.05). CONCLUSION Reduction of walker dependence by extrinsic feedback generated via DFW during walker gait training may lead to increased lower limb muscle activity and improved gait. These results could be useful for successful self-gait training and improving walking independence in patients with ISCI.
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Affiliation(s)
- Gku Bin Oh
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Republic of Korea
| | - Chang Sune Park
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Republic of Korea
| | - Ki Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Republic of Korea
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Xu S, Qian L, Hao J, Wang J, Qiu Y. Balance-Associated Tests Contribute to Predicting the Need for Ambulatory Assistive Devices (AAD) among Community-Dwelling Older Adults. Healthcare (Basel) 2023; 11:2405. [PMID: 37685439 PMCID: PMC10487081 DOI: 10.3390/healthcare11172405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/20/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
This study aims to analyze the use of ambulatory assistive devices (AAD) in relation to balance-associated tests and assist medical staff in providing professional objective reference values for older adults on whether to use AAD. Older adults (n = 228) were recruited from the local community to participate in this study. Participants were divided into the AAD-use group and the non-AAD-use group. Four balance-associated tests and scales were applied to predict the relationship between balance function and the use of AAD in older adults. They were used to assess the participant's balance function and confidence in maintaining balance and were considered the most reliable measures of balance. There were significant differences in the Berg Balance Scale (BBS) score and Timed Up and Go Test (TUGT) among the subjects in the AAD-use group and non-AAD-use group (p < 0.001). The ROC curve analysis presented the following cut-off values for balance tests and scales: 23.62 s for the TUGT test and 41.5 points for the BBS score. For example, if the TUGT score is greater than 23.62 s and the BBS score is below 41.5 points, AAD is recommended for older adults to maintain balance and prevent falls. These objective reference standards may be useful in guiding medical personnel to determine whether older adults need to use AAD. In future studies, we hope to include more participants for subgroup analysis, investigating different types of AAD and their effects on older adults.
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Affiliation(s)
- Shiqi Xu
- Wuxi School of Medicine, Jiangnan University, Wuxi 214126, China; (S.X.); (J.H.)
| | - Lei Qian
- Department of Rehabilitation, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi 214023, China;
| | - Jianru Hao
- Wuxi School of Medicine, Jiangnan University, Wuxi 214126, China; (S.X.); (J.H.)
| | - Jun Wang
- Department of Rehabilitation, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi 214023, China;
| | - Yuyu Qiu
- Wuxi School of Medicine, Jiangnan University, Wuxi 214126, China; (S.X.); (J.H.)
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Zhang Y, Tao C, Zhang X, Guo J, Fan Y. Effects of cane use on the kinematic and kinetic of lower-extremity joints in inexperienced users. J Biomech 2023; 146:111426. [PMID: 36608543 DOI: 10.1016/j.jbiomech.2022.111426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/23/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
The cane is commonly prescribed for the elderly to maintain balance and enhance independent mobility. However, improper use of cane can increase the risk of falling. Understanding the characteristics of cane gait is critical for better establishing proper cane usage norms. The paper aimed to investigate effects of cane use on kinematics and kinetics of lower extremities in the elderly and the young to guide the development of adaptive cane gait. Twenty participants (10 elder and 10 young) were recruited and walked at a self-comfortable speed or with a cane in a two-point gait. The spatiotemporal gait parameters, hip/knee/ankle joint angles and ground reaction force (GRF) were statistically analyzed using MANOVAs to assess the effects of age and cane. Using the cane significantly decreased step length, cadence and speed and increased step time in both age groups. Age and cane had significant effects on ankle plantarflexion angle in initial swing phase (APA-ISw). In cane gait, the peaks of vertical GRF(V-GRF) and anterior-posterior GRF (AP-GRF) in bilateral lower extremities significantly decreased, and the troughs of right V-GRF significantly increased for both groups. These results suggest that using a cane does interfere with the natural gait of the user and insufficient ankle plantarflexion in initial swing phase (ISw) and reduced AP-GRF may be two key risk factors contributing to cane gait instability. Therefore, the users should consider actively increasing ankle plantarflexion in ISw to avoid deteriorating gait performance due to over-reliance on the cane.
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Affiliation(s)
- Yanyu Zhang
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Sciences and Medical Engineering, Beihang University, Beijing 100083, PR China
| | - Chunjing Tao
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Sciences and Medical Engineering, Beihang University, Beijing 100083, PR China
| | - Xiaohui Zhang
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Sciences and Medical Engineering, Beihang University, Beijing 100083, PR China
| | - Jiangzhen Guo
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Sciences and Medical Engineering, Beihang University, Beijing 100083, PR China
| | - Yubo Fan
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Sciences and Medical Engineering, Beihang University, Beijing 100083, PR China
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Balkman GS, Hafner BJ, Rosen RE, Morgan SJ. Mobility experiences of adult lower limb orthosis users: a focus group study. Disabil Rehabil 2022; 44:7904-7915. [PMID: 34807780 PMCID: PMC10111250 DOI: 10.1080/09638288.2021.2002437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE People with lower limb impairments are often prescribed orthoses to preserve or enhance their mobility. Exploration of mobility experiences common among orthosis users may provide insights into how orthoses, and other mobility aids, are utilized and regarded. The objective of this study was to broadly explore how lower limb orthosis users describe their mobility. MATERIALS AND METHODS Four focus groups were held online with participants who lived in the U.S. or Canada. Participants had at least six months of experience using an ankle-foot- and/or a knee-ankle-foot-orthosis for one or both legs. All discussions were transcribed and coded. Thematic analysis was used to identify cross-cutting themes. RESULTS Participants included 29 orthosis users with a variety of health conditions. Inter-related themes, including personal factors, situational contexts, and assistance were identified as elements that influenced participants' mobility. Participants described a process of modifying their mobility through the use and non-use of one or more mobility aids. CONCLUSIONS The current study findings may assist clinicians in developing strategies to optimize orthosis users' mobility in different situations. Experiences described by participants in this study may also help researchers identify aspects of mobility most pertinent to orthosis users and inform the development of new outcome measures.Implications for RehabilitationPeople who use lower-limb orthoses share common mobility experiences, despite differences in health diagnoses.Orthosis users often have opportunities to modify their mobility by choosing to use or not use their brace(s) and/or handheld mobility aids.When providing mobility aid interventions, clinicians should consider how each patient's individual characteristics, including physical characteristics (e.g., the health condition and how it presents, pain, fatigue) and psychosocial characteristics (e.g., fear and confidence, self-motivation, emotional responses), can affect mobility.Clinicians may be able to help patients optimize their mobility by asking about environmental obstacles they regularly encounter and recommending strategies for utilization of mobility aids, including simultaneous use of multiple aids, use of one aid, or choosing not to use any aids, depending on the activity and situation.Clinicians should inquire about all mobility aids available to a patient at home and in the community, including fixed objects, and consider how new mobility aid interventions might affect the patient's mobility when used alone and in combination with other forms of assistance.
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Affiliation(s)
- Geoffrey S. Balkman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rachael E. Rosen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sara J. Morgan
- Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
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Omana HA, Madou E, Divine A, Wittich W, Hill KD, Johnson AM, Holmes JD, Hunter SW. The effect of first-time 4-wheeled walker use on the gait of younger and older adults. PM R 2022; 14:1333-1342. [PMID: 34464511 DOI: 10.1002/pmrj.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required. OBJECTIVE To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults. DESIGN Cross-sectional, repeated-measures. SETTING Community-dwelling. PARTICIPANTS Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people not requiring the use of a walking aid, and those able to converse in English. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Gait velocity and stride time variability were recorded using accelerometers. Gait was examined under three conditions: unassisted walking; walking with a 4-wheeled walker; and walking with a 4-wheeled walker while completing a secondary task. Conditions were performed across two walking paths: straight and figure-of-8 Walk Test. Separate mixed-methods analyses of variance (ANOVAs; within-subject: condition/path; between-subject: group) were used for statistical analyses. RESULTS Velocity was lower when walking using a walker while completing a cognitive task (p < .001), in the figure-of-8 Walk Test (p < .001), and in older adults (p = .001). Stride time variability increased with walking path and condition difficulty (p < .001) for the straight path versus the figure-of-8 Walk Test. CONCLUSIONS Using a 4-wheeled walker resulted in a slower and more inconsistent gait pattern across both age groups. Walking more complex configurations resulted in the prioritization of gait over the cognitive task while performing the dual-task conditions. No evidence of an age-related difference in the effect of initial walker use on gait was observed. Nonetheless, walkers are cognitively demanding and their introduction should warrant a clinical follow-up.
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Affiliation(s)
- Humberto A Omana
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Edward Madou
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Alison Divine
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Walter Wittich
- École d'optométrie, Université de Montréal, Montreal, Quebec, Canada
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living Research Centre, Monash University, Clayton, Victoria, Australia
| | - Andrew M Johnson
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| | - Jeffrey D Holmes
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Park S, Finley JM. Manual stabilization reveals a transient role for balance control during locomotor adaptation. J Neurophysiol 2022; 128:808-818. [PMID: 35946807 PMCID: PMC9550585 DOI: 10.1152/jn.00377.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 01/26/2023] Open
Abstract
A fundamental feature of human locomotor control is the need to adapt walking patterns in response to changes in the environment. For example, when people walk on a split-belt treadmill, which has belts that move at different speeds, they adapt to the asymmetric speed constraints by reducing spatiotemporal asymmetry. Here, we aim to understand the role of balance control as a potential factor driving this adaptation process. We recruited 24 healthy, young adults to adapt to walking on a split-belt treadmill while either holding on to a handrail or walking with free arm swing. We measured whole body angular momentum and step length asymmetry as measures of dynamic balance and spatiotemporal asymmetry, respectively. To understand how changes in intersegmental coordination influenced whole body angular momentum, we also measured segmental angular momenta and the coefficient of cancellation. When participants were initially exposed to the asymmetry in belt speeds, we observed an increase in whole body angular momentum that was due to both an increase in the momentum of individual segments and a reduction in the coefficient of cancellation. Holding on to a handrail reduced the perturbation to asymmetry during the early phase of adaptation and resulted in a smaller aftereffect during early postadaptation. In addition, the stabilization provided by holding on to a handrail led to reductions in the coupling between angular momentum and asymmetry. These results suggest that regulation of dynamic balance is most important during the initial, transient phase of adaptation to walking on a split-belt treadmill.NEW & NOTEWORTHY We investigated the role of dynamic balance during adaptation to a split-belt treadmill by measuring whole body angular momentum with or without holding on to a handrail. The initial step length asymmetry and associations between balance and asymmetry reduced when holding on to a handrail during early adaptation. These findings indicate that dynamic balance mostly contributes to the initial phase of adaptation when people are exposed to an asymmetric walking constraint.
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Affiliation(s)
- Sungwoo Park
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California
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Sansare A, Arcodia M, Lee SCK, Jeka J, Reimann H. Individuals with cerebral palsy show altered responses to visual perturbations during walking. Front Hum Neurosci 2022; 16:977032. [PMID: 36158616 PMCID: PMC9493200 DOI: 10.3389/fnhum.2022.977032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with cerebral palsy (CP) have deficits in processing of somatosensory and proprioceptive information. To compensate for these deficits, they tend to rely on vision over proprioception in single plane upper and lower limb movements and in standing. It is not known whether this also applies to walking, an activity where the threat to balance is higher. Through this study, we used visual perturbations to understand how individuals with and without CP integrate visual input for walking balance control. Additionally, we probed the balance mechanisms driving the responses to the visual perturbations. More specifically, we investigated differences in the use of ankle roll response i.e., the use of ankle inversion, and the foot placement response, i.e., stepping in the direction of perceived fall. Thirty-four participants (17 CP, 17 age-and sex-matched typically developing controls or TD) were recruited. Participants walked on a self-paced treadmill in a virtual reality environment. Intermittently, the virtual scene was rotated in the frontal plane to induce the sensation of a sideways fall. Our results showed that compared to their TD peers, the overall body sway in response to the visual perturbations was magnified and delayed in CP group, implying that they were more affected by changes in visual cues and relied more so on visual information for walking balance control. Also, the CP group showed a lack of ankle response, through a significantly reduced ankle inversion on the affected side compared to the TD group. The CP group showed a higher foot placement response compared to the TD group immediately following the visual perturbations. Thus, individuals with CP showed a dominant proximal foot placement strategy and diminished ankle roll response, suggestive of a reliance on proximal over distal control of walking balance in individuals with CP.
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Affiliation(s)
- Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Maelyn Arcodia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Samuel C. K. Lee
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - John Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
- *Correspondence: Hendrik Reimann,
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Lee DCA, Burton E, Meyer C, Hunter SW, Suttanon P, Hill KD. Gait aid use for people with and without dementia: A comparison of practice between health and non-health professionals among Australian community care staff. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1721-e1733. [PMID: 34617351 DOI: 10.1111/hsc.13600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Gait aid provision is a standard approach to improve mobility and balance for older people. This research aims to understand and compare community care staff practice (health vs. non-health professionals) for gait aid use by people with and without dementia. A cross-sectional survey was conducted with Australian community care staff between October 2020 and February 2021. Survey items consisted of closed/open-ended questions to explore staff practice for people with/without dementia, and assessments/procedures health professionals used for people with dementia. Likert-scale items gauged staff agreement on factors that influenced their decisions regarding gait aid use for people with dementia. Univariate logistic regression analyses were used to examine staff practice for people with/without dementia and their interaction effects, and factors that influenced decision-making regarding gait aid use for people with dementia. Content analyses were used to collate responses on assessments/procedures used for people with dementia. Health (n = 109) and non-health professionals (n = 138) completed the survey. Compared with non-health professionals, health professionals were more likely to (1) refer the person without dementia [odds ratio, 95% CI: 23.9 (12.1, 47.3), p < .01] and person with dementia [27.8 (12.5, 61.7), p < .01] to a physiotherapist for gait aid assessment, (2) agree with gait aid use if the person with dementia: (a) lives with someone who can monitor gait aid safety [coefficient, 95% CI: -0.75 (-1.29, -0.21), p = .01], (b) performs well on a cognitive functional screen [-0.68 (-1.20, -0.16), p = .01] and (c) gives feedback about gait aid use [-0.64 (-1.15, -0.12), p = .02]. No interaction effects existed between health/non-health professionals and whether the person had dementia/no dementia on the practice options examined. Health professionals infrequently reported using single/dual task, simple/complex gait or motor sequence testing to assess people with dementia for gait aid use. Strategies such as developing decision aid tool(s) may guide mobility practice for community care staff.
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Affiliation(s)
- Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Victoria, Australia
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Plaiwan Suttanon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Keith D Hill
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
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Lawrason SVC, Brown-Ganzert L, Campeau L, MacInnes M, Wilkins CJ, Martin Ginis KA. mHealth Physical Activity Intervention for Individuals With Spinal Cord Injury: Planning and Development Processes. JMIR Form Res 2022; 6:e34303. [PMID: 35984695 PMCID: PMC9440410 DOI: 10.2196/34303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023] Open
Abstract
Background Interventions to support physical activity participation among individuals with spinal cord injury (SCI) are required given this population’s low levels of physical activity and extensive barriers to quality physical activity experiences. Objective This study aimed to develop a mobile health intervention, called SCI Step Together, to improve the quantity and quality of physical activity among individuals with SCI who walk. Methods Our overarching methodological framework was the Person-Based approach. This included the following 4 steps: conduct primary and secondary research (step 1); design intervention objectives and features (step 2a); conduct behavioral analysis and theory (step 2b); create a logic model (step 3); and complete the SCI Step Together program content and integrated knowledge translation (IKT; step 4), which occurred throughout development. The partnership approach was informed by the SCI IKT Guiding Principles. Three end users pilot-tested the app and participated in the interviews. Results Step 1 identified issues to be addressed when designing intervention objectives and features (step 2a) and features were mapped onto the Behavior Change Wheel (step 2b) to determine the behavior change techniques (eg, action planning) to be included in the app. The logic model linked the mechanisms of action to self-determination theory (steps 2/3). Interviews with end users generated recommendations for the technology (eg, comparing physical activity levels with guidelines), trial (eg, emailing participants’ worksheets), and intervention content (eg, removing graded tasks; step 4). Conclusions Using the SCI IKT Guiding Principles to guide partner engagement and involvement ensured that design partners had shared decision-making power in intervention development. Equal decision-making power maximizes the meaningfulness of the app for end users. Future research will include testing the acceptability, feasibility, and engagement of the program. Partners will be involved throughout the research process. Trial Registration ClinicalTrials.gov: NCT05063617; https://clinicaltrials.gov/ct2/show/NCT05063617
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Affiliation(s)
- Sarah Victoria Clewes Lawrason
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| | | | | | | | - C J Wilkins
- Community Research Partner, Kelowna, BC, Canada
| | - Kathleen Anne Martin Ginis
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Kudelka J, Geritz J, Welzel J, Hildesheim H, Maetzler C, Emmert K, Niemann K, Hobert MA, Pilotto A, Bergmann P, Maetzler W. What contributes most to the SPPB and its subscores in hospitalized geriatric patients: an ICF model-based approach. BMC Geriatr 2022; 22:668. [PMID: 35963992 PMCID: PMC9375907 DOI: 10.1186/s12877-022-03358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mobility deficits are highly prevalent among geriatric patients and have serious impact on quality of life, hospitalizations, and mortality. This study aims to capture predictors of mobility deficits in hospitalized geriatric patients using the International Classification of Functioning, Disability and Health (ICF) model as a framework. Methods Data were obtained from n = 397 patients (78 ± 7 years, 15 ± 7 ICD-11 diagnoses) on a geriatric ward at time of admission. Mobility was assessed using the Short Physical Performance Battery (SPPB) total score and gait, static balance and transfer subscores. Parameters from an extensive assessment including medical history, neuropsychological and motor examination, and questionnaires were assigned to the five components of the ICF model. Spearman’s Correlation and multiple linear regression analyses were calculated to identify predictors for the SPPB total score and subscores. Results Use of walking aid, fear of falling (FOF, but not occurrence of previous falls), participation in society, ADL and grip strength were strongly associated with the SPPB total score and all subscores (p < .001). FOF and grip strength were significant predictors for the SPPB total score as well as for gait and transfer subscores. FOF also showed a strong association with the static balance subscore. The clinical parameters of the ICF model could only partially explain the variance in the SPPB total score (24%) and subscores (12–23%), with no parameter from the activities and participation component being significantly predictive. Conclusions FOF and reduced grip strength are associated with mobility deficits in a hospitalized geriatric cohort. Further research should focus on interventions to reduce FOF and increase muscle strength in geriatric patients. Moreover, there is a need for ICF-based assessments instruments (especially in the activities and participation components) that allow a holistic view on mobility and further daily life-relevant health aspects in geriatric patients.
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Affiliation(s)
- Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Hanna Hildesheim
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Kirsten Emmert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Katharina Niemann
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Markus A Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Philipp Bergmann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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The Effects of Pedestrian Environment on Ambulation with a Walking Frame in Elderly Individuals: A Survey and Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159327. [PMID: 35954684 PMCID: PMC9368263 DOI: 10.3390/ijerph19159327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023]
Abstract
Understanding the effects of sloped roads in the pedestrian environment on the body during ambulation with a walking frame can help design friendlier living environments for elderly individuals. A survey of the characteristics of walking frames used in different pedestrian environments was investigated in five communities, and a controlled study of the effects of a sloped road on a subject with different walking frames was carried out as foundational research in the laboratory. A synchronous acquisition system consisting of a wireless motion capture module and a physiological information recording module was applied to collect data on the motion of the shoulder joint and skin conductance response (SCR) of fingers in one participant. Force data were collected from sensors placed on the four legs of the walking frame. The experimental data obtained during different tasks were quantitatively analyzed. Compared to flat ground, the shoulder joint rotated in the opposite direction in horizontal and internal/external planes when using a wheeled walking frame on an uphill road, and the supportive force decreased on both uphill and downhill roads. The range of motion of the shoulder joint reduced and the direction of the shoulder joint motion changed when using a footed walking frame on both uphill and downhill roads. Additionally, the peak value of the supportive force on the uphill road appeared in the first 50% of the gait cycle, which was earlier than in the other cases. In addition, walking on the uphill road with a walking frame had a maximum SCR value, which means a greater impact of psychological arousal. Biomechanics of the shoulder joint and psychological arousal are closely related to the ease of walking on a sloped road with a walking frame. These findings are beneficial for designing more appropriate environments for elderly individuals who walk with aids.
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Omaña H, Madou E, Hunter SW. The Effects on Gait of 4-Wheeled Walker Use in People with Alzheimer’s Disease Dementia and Gait Impairment: A Pilot Study. J Alzheimers Dis 2022; 89:399-404. [DOI: 10.3233/jad-220331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In people with dementia, provision of mobility aids is standard treatment for those with impaired gait. However, mobility aid use is independently associated with increased falls risk. In this short communication, gait velocity and stride time variability were recorded in eleven adults with Alzheimer’s disease dementia. Three conditions were tested: single-task (no aid), walking with a walker, and dual-task (walker use and counting backwards) under both a straight path and Figure-of-8 walking configuration. Gait velocity increased when using a walker compared to no aid in the Figure-of-8 walking configuration. Walker use improved gait in simple walking, but benefits diminished upon dual-task.
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Affiliation(s)
- Humberto Omaña
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Edward Madou
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Susan W. Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Krafft FC, Herzog M, Stein T, Sloot LH. Young Individuals Are More Stable and Stand More Upright When Using Rollator Assistance During Standing up and Sitting Down. Front Bioeng Biotechnol 2022; 10:876349. [PMID: 35898645 PMCID: PMC9309795 DOI: 10.3389/fbioe.2022.876349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Four-wheeled walkers or rollators are often used to assist older individuals in maintaining an independent life by compensating for muscle weakness and reduced movement stability. However, limited biomechanical studies have been performed to understand how rollator support affects posture and stability, especially when standing up and sitting down. Therefore, this study examined how stability and posture change with varying levels of rollator support and on an unstable floor. The aim was to collect comprehensive baseline data during standing up and sitting down in young participants. In this study, 20 able-bodied, young participants stood up and sat down both 1) unassisted and assisted using a custom-made robot rollator simulator under 2) full support and 3) touch support. Unassisted and assisted performances were analyzed on normal and unstable floors using balance pads with a compliant surface under each foot. Using 3D motion capturing and two ground-embedded force plates, we compared assistive support and floor conditions for movement duration, the relative timing of seat-off, movement stability (center of pressure (COP) path length and sway area), and posture after standing up (lower body sagittal joint angles) using ANOVA analysis. The relative event of seat-off was earliest under full support compared to touch and unassisted conditions under normal but not under unstable floor conditions. The duration of standing up and sitting down did not differ between support conditions on normal or unstable floors. COP path length and sway area during both standing up and sitting down were lowest under full support regardless of both floor conditions. Hip and knee joints were least flexed under full support, with no differences between touch and unassisted in both floor conditions. Hence, full rollator support led to increased movement stability, while not slowing down the movement, during both standing up and sitting down. During standing up, the full support led to an earlier seat-off and a more upright standing posture when reaching a stable stance. These results indicate that rollator support when handles are correctly aligned does not lead to the detrimental movement alterations of increased forward-leaning. Future research aims to verify these findings in older persons with stability and muscle weakness deficiencies.
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Affiliation(s)
- F. C. Krafft
- Optimization, Robotics, and Biomechanics (ORB), Institute of Technical Engineering (ZITI), Heidelberg University, Heidelberg, Germany
- HEiKA—Heidelberg Karlsruhe Strategic Partnership, Karlsruhe Institute of Technology (KIT), Heidelberg University, Heidelberg, Germany
| | - M. Herzog
- HEiKA—Heidelberg Karlsruhe Strategic Partnership, Karlsruhe Institute of Technology (KIT), Heidelberg University, Heidelberg, Germany
- BioMotion Center, Institute of Sports and Sports Science (IFSS), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- *Correspondence: M. Herzog,
| | - T. Stein
- HEiKA—Heidelberg Karlsruhe Strategic Partnership, Karlsruhe Institute of Technology (KIT), Heidelberg University, Heidelberg, Germany
- BioMotion Center, Institute of Sports and Sports Science (IFSS), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - L. H. Sloot
- Optimization, Robotics, and Biomechanics (ORB), Institute of Technical Engineering (ZITI), Heidelberg University, Heidelberg, Germany
- HEiKA—Heidelberg Karlsruhe Strategic Partnership, Karlsruhe Institute of Technology (KIT), Heidelberg University, Heidelberg, Germany
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Friesen KB, Lanovaz JL, Moraes R, Oates AR. Don't get tripped up: Haptic modalities alter gait characteristics during obstacle crossing. Hum Mov Sci 2022; 82:102935. [DOI: 10.1016/j.humov.2022.102935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
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Kuntze G, Russell M, Jivan S, Ronsky JL, Manocha RHK. The effect of axillary crutch length on upper limb kinematics during swing-through gait. PM R 2022; 15:570-578. [PMID: 35343643 DOI: 10.1002/pmrj.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Axillary crutches are commonly used in rehabilitation. Inappropriately fit crutches may result in upper limb pain or injury. OBJECTIVE To investigate the effects of axillary crutch length on upper limb kinematics to better understand potential injury mechanisms. It was hypothesized that crutches that were longer or shorter than standard-fit crutches would alter upper limb kinematics. DESIGN Cross-sectional. SETTING Gait laboratory. PARTICIPANTS Fifteen healthy males with no prior crutch experience. INTERVENTIONS Participants were fit with axillary crutches using standardized methods, as well as with crutches that were 5 cm longer and 5 cm shorter. Participants performed swing-through gait (1.20 ± 0.07 ms-1 ) with all crutch lengths in randomized order. Kinematics were recorded using an optical motion-tracking system and joint angles for the scapula, shoulder, elbow, and wrist were computed. MAIN OUTCOME MEASURES The effects of crutch length on joint range of motion (ROM) and joint angles at initial crutch contact were analyzed using multivariate analysis (Hotelling's T2 ; α = .025) and simultaneous confidence intervals (CI). RESULTS The long-standard crutch fit comparison showed effects across all joints (ROM p = .009; initial contact p < .001). Longer crutches resulted in greater scapular upward rotation (mean difference [95% CI] ROM: 1.0 [-0.2 to 2.2]; initial contact: -2.7 [-4.4, -1.1]) and shoulder abduction (ROM: 0.8 [-0.1 to 1.8]; initial contact: -1.9 [-4.1 to 0.3]). Crutch length also had effects across all joints for the short-standard fit comparison (ROM p = .004; initial contact p = .016). Shorter crutches resulted in greater scapula downward rotation (2.2 [-0.4 to 4.8]) and greater shoulder adduction (2.5 [-0.6 to 5.6]) at initial contact. Shorter crutches also reduced shoulder flexion/extension ROM (-2.5 [-4.4 to -0.6]). CONCLUSIONS Altered crutch length results in scapular and shoulder kinematic deviations that may present risk factors for upper limb injury with crutch-walking. This may underline the importance of appropriate device fitting to reduce injury risk in crutch users.
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Affiliation(s)
- Gregor Kuntze
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Monica Russell
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Shaine Jivan
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Janet Lenore Ronsky
- Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Ranita Harpreet Kaur Manocha
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Division of Physical Medicine & Rehabilitation, University of Calgary, Calgary, Alberta, Canada
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Toth AL, Fenrich KK, Jones KE, Misiaszek JE. Coupling of single cutaneous afferents in the hand with ankle muscles, and their response to rapid light touch displacements. J Neurophysiol 2022; 127:1040-1053. [PMID: 35320053 DOI: 10.1152/jn.00280.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Light touch reduces sway during standing. Unexpected displacement of a light touch reference at the finger can produce rapid responses in ankle muscles when standing, suggesting cutaneous receptors in the hand are functionally coupled with ankle muscles. Using microneurography in the median nerve, we tested the hypotheses: 1) that cutaneous afferent activity of mechanoreceptors of the hand would modulate electromyographic (EMG) activity of ankle muscles, and 2) that displacement of a light touch contact across a receptor's sensory territory would be encoded in the afferent activity. Spike-triggered averaging of EMG activity of tibialis anterior (TA) and soleus (SOL) demonstrated thirty-four of forty-two (81%) cutaneous afferents recorded modulated activity of ankle muscles with latencies between 40 to 119 ms. Cutaneous afferents of all types (slow and fast adapting, types I and II) demonstrated responses in TA and SOL, in both the ipsilateral and contralateral leg. Activity from eleven cutaneous afferents were recorded while a light touch contact was displaced across their receptive fields. Afferent activity increased with stimulus onset and remained elevated for the stimulus duration for all afferents recorded. These results suggest cutaneous afferents from the hand consistently form connections with motor pools of the leg at latencies implicating spinal pathways. In addition, the same population of afferents is readily excited by the displacement of a light touch contact. Therefore, cutaneous receptors of the hand can be recruited and utilized to alter motoneuron pool excitability in muscles important to balance control, at latencies relevant for rapid balance responses.
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Affiliation(s)
- Aidan L Toth
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Keith K Fenrich
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kelvin E Jones
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - John E Misiaszek
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
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Functional Decline After Nonhospitalized Injuries in Older Patients: Results From the Canadian Emergency Team Initiative Cohort in Elders. Ann Emerg Med 2022; 80:154-164. [DOI: 10.1016/j.annemergmed.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/23/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022]
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Lee DCA, Meyer C, Burton E, Kitchen S, Williams C, Hunter SW, Suttanon P, Hill KD. A survey of nurses, physiotherapists and occupational therapists in mobility care and gait aid use for hospital patients with dementia. Geriatr Nurs 2022; 44:221-228. [PMID: 35240401 DOI: 10.1016/j.gerinurse.2022.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 12/24/2022]
Abstract
This study described mobility care practice of nurses, physiotherapists and occupational therapists and gait aid use for hospital patients with dementia. Two surveys, tailored to staff mobility care roles were distributed in Australian hospitals. Physiotherapists and occupational therapists were asked additional questions regarding assessments and factors for prescribing gait aids to patients with dementia. Descriptive statistics for closed-ended and summative content analyses for open-ended questions were undertaken. Nurses (n=56), physiotherapists (n=11) and occupational therapists (n=23) used various practices to ensure ambulation safety for patients with dementia. Nurses and occupational therapists commonly referred patients with dementia to physiotherapists for mobility and gait aid assessments. Therapists predominantly considered the severity of dementia, the person's learning ability and mobility history in deciding about gait aid use. Exploring ways to strengthen nursing and health professional education, and inter-professional practice for safe mobility in patients with dementia, with and without gait aids, could be helpful.
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Affiliation(s)
- Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia; Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria 3199, Australia.
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria 3199, Australia; Bolton Clarke Research Institute, Bolton Clarke, Forest Hill, Victoria 3131, Australia; Centre for Health Communication and Participation, La Trobe University, Bundoora, Victoria 3083, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia 6102, Australia; enAble Institute, Curtin University, Bentley, Western Australia 6102, Australia
| | - Su Kitchen
- Sir Charles Gairdner Osbourne Park Health Care Group, Nedlands, Western Australia 6009, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, Ontario N6A 3K7, Canada
| | - Plaiwan Suttanon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Bangkok 10200, Thailand
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria 3199, Australia; National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia 3199
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Sivakumar A, Bennett K, Rickman M, Thewlis D. An instrumented walker in three-dimensional gait analysis: Improving musculoskeletal estimates in the lower limb mobility impaired. Gait Posture 2022; 93:142-145. [PMID: 35149244 DOI: 10.1016/j.gaitpost.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In three-dimensional (3D) gait analysis of individuals requiring a walking frame (walker), acquisition of artefact-free motion and force data is challenging. Without inclusion of handle-reaction forces alongside ground reaction forces, external forces used in musculoskeletal modelling are incomplete. This may increase dynamic inconsistencies between the model and measured motions and forces, thus, uncertainties in estimates of musculoskeletal load. RESEARCH QUESTION To develop an instrumented walker and evaluate the effects of including handle-reaction forces on residual forces during musculoskeletal modelling. METHODS An instrumented walker measuring handle-reaction forces synchronously with motion capture and ground reaction force data was developed. 3D gait analysis was conducted in ten elderly participants recovering from a proximal femur fracture and requiring a walker for ambulation. Joint kinetics and residual forces were calculated between two external load conditions: (1) external loads applied using only force platforms; or (2) external loads applied using force platforms and walker handle-reaction forces. RESULTS Including handle-reaction forces reduced residual forces and improved estimates of musculoskeletal loads of the torso (P = <0.001). SIGNIFICANCE A wide instrumented walker measuring handle-reaction forces allows for the gait analysis of individuals requiring a walker and improves reliability of musculoskeletal dynamics.
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Affiliation(s)
- Arjun Sivakumar
- Centre for Orthopaedic & Trauma Research, University of Adelaide, SA, Australia.
| | - Kieran Bennett
- Centre for Orthopaedic & Trauma Research, University of Adelaide, SA, Australia
| | - Mark Rickman
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, SA, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic & Trauma Research, University of Adelaide, SA, Australia; Department of Orthopaedics & Trauma, Royal Adelaide Hospital, SA, Australia
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