Specific smartphone usage and cognitive performance affect gait characteristics during free-living and treadmill walking

Does listening to audiobooks affect gait behavior?

BACKGROUND

The effect of listening to audiobooks, podcasts, and other audio files while walking on gait performance has not been well studied. Although the number of audio users is growing annually. Evidence suggests that a posture-first strategy contributes to gait stability in healthy individuals during dual-task conditions, but this effect may be diminished when the cognitive task is consciously prioritized.

OBJECTIVES

To study the effect of listening to an audiobook while walking, as a daily life-like dual-task, on spatiotemporal gait parameters.

METHODS

Forty young healthy (24.05 ± 3.66) subjects participated in the study. Spatiotemporal gait parameters were measured for 5 min on a treadmill once without (single-task) and once while listening to an audiobook through over-ear headphones (dual-task). Measured parameters included spatiotemporal parameters, gait phases, maximum pressure, and dual-task cost. Data were statistically analyzed using SPSS software.

RESULTS

There were no significant differences in any of the studied parameters between the single- and dual-task conditions, even though the subjective cognitive load of listening to audiobooks while walking was high. However, participants with different habits had significant differences in gait phases and maximum pressure. Rare listeners had a shorter stance phase, a longer swing phase, and a higher maximum pressure on the dominant heel. They also had significant differences in dual-task costs.

CONCLUSION

No differences in the spatiotemporal gait parameters for walking with and without listening to audiobooks, as a daily life-like dual-task, were observed. However, the difference between participants who listened rarely and participants who listened often may confirm the "posture first" strategy in young healthy people.

TRIAL REGISTRATION

DRKS00025837, retrospectively registered on 23.11.2021.

Effects of smartphone use while walking on external knee abduction moment peak: A crossover randomized trial on an instrumented treadmill

Introduction

In addition to its effects on cognitive awareness, smartphone use while walking may reduce the speed, regularity, and symmetry of walking. Although its effects on spatiotemporal gait parameters, such as walking speed and step width, have already been studied, little is currently known about the impact of smartphone dual tasking on lower limb kinetics.

Research question

Does smartphone use during walking alter gait patterns (i.e., walking speed and step width) and consequently external knee moments?

Methods

In a four-period crossover trial, external knee moment peaks, walking speed, and step width were assessed in 27 healthy adults during matched-speed walking, self-paced walking, self-paced walking with spoken calculation tasks, and self-paced walking with smartphone-entered calculation tasks. Differences between the smartphone use condition and all other conditions were determined using repeated measures ANOVA with predefined contrasts.

Results

Decreased walking speed and increased step width were observed during smartphone use. The mean external knee abduction moment peak (Nm/kg) differed significantly (p < 0.01) across the intervention condition, namely walking with smartphone-entered calculations (0.15; 95 % CI: 0.12, 0.18), and the control conditions, namely matched-speed walking (0.11; 95 % CI: 0.08, 0.13), self-paced walking (0.11; 95 % CI: 0.09, 0.14), and walking with spoken calculations (0.14; 95 % CI: 0.12, 0.16). After confounder adjustment for walking speed, step width, gender, and age, this primary outcome was significantly different between using the smartphone and self-paced walking (p < 0.01, r = 0.51). This effect size was reduced when comparing smartphone use with spoken calculations (p = 0.04, r = 0.32).

Conclusion

When using a smartphone while walking, walking speed is slowed down, step width is increased, and knee moments are adversely altered compared to walking without dual tasking. These altered knee moments are partially, but not entirely, attributable to the cognitive calculation task. These effects are age-independent, but women are more affected than men. Nevertheless, it remains unclear whether sustained walking while using a smartphone adversely affects the development of knee joint pathologies.

Smartphone Use-Influence on Posture and Gait during Standing and Walking

Prolonged gaze at a smartphone is characterized by pronounced flexion of the cervical spine and is associated with health risks. In addition, it is suspected that smartphone distraction could lead to gait changes. Therefore, the aim of this study was to detect smartphone-associated postural changes at thoracic and lumbar levels as well as gait changes. Spinal analysis was performed prospectively in 21 healthy men using the DIERS 4Dmotion®Lab in a controlled crossover design to evaluate posture-associated parameters while standing and walking. The examination sequence provided three randomized gaze directions: GN = Gaze Neutral; S1H = Smartphone one-handed; S2H = Smartphone two-handed. Results reveal a higher vertebra prominens (VP)-flexion in S1H (23.8° ± 6.9°; p ≤ 0.001) and S2H (22.4° ± 4.7°; p ≤ 0.001) compared to GN (17.6° ± 3.8°). Kyphosis angles were also different with higher values observed in S1H (58.8° ± 5.8°; p ≤ 0.001) and S2H (61.6° ± 4.9°; p ≤ 0.001) compared to GN (49.1° ± 4.6°). During walking, similar results were observed in kyphosis angles. No differences were observed in gait during smartphone use (p = 0.180-0.883). The study revealed a significantly increased inclination of the lower cervical and thoracic spine during smartphone use. However, the inclination was larger during S2H. Standing or walking conditions did not affect the measurement outcomes. Long-term smartphone use associated with a larger inclination of the cervical and thoracic spine might result in increased pressure and shear forces acting on vertebral bodies, intervertebral discs, and muscles, which potentially increases the risk of spinal pain and disease.

Impact of Using Smartphone While Walking or Standing: A Study Focused on Age and Cognition

BACKGROUND

Using smartphones during a task that requires upright posture is suggested to be detrimental for the overall motor performance. The aim of this study was to determine the role of age and specific aspects of cognitive function on walking and standing tasks in the presence of smartphone use.

METHODS

51 older (36 women) and 50 young (35 women), mean age: 66.5 ± 6.3 and 22.3 ± 1.7 years, respectively, were enrolled in this study. The impact of using a smartphone was assessed during a dynamic (timed up and go, TUG) and a static balance test (performed on a force platform). Multivariate analyses of variance were applied to verify main effects of age, task, estimates of cognitive function and interactions.

RESULTS

Compared to young, older individuals exhibited a poorer performance on the dynamic and on the static test (age effect: p = 0.001 for both variables). Dual-tasking with a smartphone had a negative impact on both groups (task effect: p = 0.001 for both variables). The negative impact, however, was greater in the older group (age × task effect: p = 0.001 for both variables). Executive function and verbal fluency partially explained results of the dynamic and static tests, respectively.

CONCLUSIONS

The negative impact of using a smartphone while performing tasks similar to daily activities is higher in older compared to young people. Subclinical deficits in distinct aspects of cognitive function partially explain the decreased performance when dual-tasking.

Effects of Mobile Phone Use on Gait and Balance Control in Young Adults: A Hip-Ankle Strategy

BACKGROUND

This study aimed to derive the effects of walking while using a mobile phone on balance perturbation and joint movement among young adults.

METHODS

Sixteen healthy college students with no history of brain injury were tested. The participants were asked to walk under four different conditions: (1) walking, (2) browsing, (3) dialing, and (4) texting. Indicators related to balance control and lower limb kinematic/kinetic parameters were analyzed using the continuous relative phase and statistical nonparametric mapping methods.

RESULTS

Walking while using a mobile phone slowed participants' gait speed and reduced the cadence, stride length, and step length. The posterior tilt angle (0-14%, 57-99%), torque of the hip flexion (0-15%, 30-35%, 75-100%), and angle of the hip flexion (0-28%, 44-100%) decreased significantly. The activation of biceps femoris and gastrocnemius, hip stiffness, and ankle stiffness increased significantly. This impact on gait significantly differed among three dual tasks: texting > browsing > dialing.

CONCLUSION

Che overlap of walking and mobile phone use affects the gait significantly. The "hip-ankle strategy" may result in a "smooth" but slower gait, while this strategy was deliberate and tense. In addition, this adjustment also increases the stiffness of the hip and ankle, increasing the risk of fatigue. Findings regarding this effect may prove that even for young healthy adults, walking with mobile phone use induces measurable adjustment of the motor pattern. These results suggest the importance of simplifying the control of the movement.

Foot pressure-based analysis of gait while using a smartphone

BACKGROUND

The number of incidents related to walking while using smartphones is rising. However, it is not clear how smartphone usage might affect a gait pattern in terms of the foot pressure, and this may address the mechanism leading to incidents while using smartphones.

RESEARCH QUESTION

How do the characteristics of walking while using a smartphone affect foot pressure patterns?

METHODS

In this cross-sectional study, we recruited 40 healthy young participants and investigated the walking speed, step length, coefficient of variance of the walking cycle (CV), anteroposterior length of the center of pressure (COP) trajectory (%Long), partial foot pressure ratios (% partial foot pressure [%PFP]), and COP existence time (COPexT) under the following four conditions: normal walking, screen gazing, while using social networking services (SNS), and while using a cognitive application. Parameters were compared among the four conditions using a repeated-measures ANOVA. Further, according to the presence or absence of an incident history (e.g. stumbles, collisions), participants were divided into either the incident or non-incident group. Parameters were compared between the two groups using a two-way repeated-measures ANOVA.

RESULTS

Under the SNS and cognitive application conditions, the walking speed, step length, %Long, %PFP, and COPexT in the heel were significantly lower, and the CV and %PFP in the metatarsal region were higher than those under normal walking or screen gazing. %PFP in the heel and metatarsal regions showed a significant group-by-condition interaction; the incident group had lower %PFP in the heel region and higher %PFP in the metatarsal region than the non-incident group.

SIGNIFICANCE

These findings indicate a trend of loading more pressure on the forefoot than on the heel. This pattern was markedly evident in individuals with a history of incidents related to the smartphone usage and may be one of the factors causing stumbles and collisions.

Turning when using a smartphone in persons with and without neurologic conditions: an observational study (Preprint)

BACKGROUND

Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions.

OBJECTIVE

This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases.

METHODS

Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm.

RESULTS

In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use.

CONCLUSIONS

Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998.

The Impact of Using Mobile Phones on Gait Characteristics: A Narrative Review

The aim of this study was to summarize the research status and reveal the impact of mobile phone use on gait characteristics by reviewing the existing studies in terms of research status, participants, independent variables, dependent variables, main findings, etc. Twenty-nine studies which investigated the impact of using mobile phones on gait characteristics were identified through a literature search. The majority of these studies examined the effects of mobile phone use on gait characteristics in young people. The preliminary results showed that walking while using a mobile phone has significant impacts on gait. It can decrease gait velocity, cadence, step length and stride length, along with significantly increasing step width, step time and double support time. The results varied among different mobile phone usage, which resulted from the different motor and mental demands. Additionally, age and environment could affect the results as well. As well as the kinematic characteristics, we suggest that kinetic and EMG analysis are conducted in future studies.

Impact of walking states, self-reported daily walking amount and age on the gait of older adults measured with a smart-phone app: a pilot study

BACKGROUND

Smartphones provide a cost-effective avenue for gait assessment among older adults in the community. The purpose of this study is to explore the impact of walking state, self-reported daily walking amount, and age on gait quality, using a smartphone application.

METHODS

One hundred older adult individuals from North China, aged 73.0 ± 7.7 years, voluntarily participated in this study. They performed three walking tests: normal walking, fast walking, and visually impaired walking. Three-dimensional acceleration data for gait were obtained using the smartphone app Pocket Gait. This study used multivariate analysis of variance (MANOVA) to explore the effects of the walking state, self-reported daily walking amount, and age on the step frequency, root mean square (RMS) acceleration, step time variability, regularity, and symmetry.

RESULTS

The walking state, self-reported daily walking amount, and age had statistically significant effects on gait quality. Compared with normal walking, the step frequency, RMS acceleration, variability, and regularity were greater in the fast-walking state, and simulated visually impaired walking did not significantly affect gait quality. Relatively older individuals had a significant decline in gait quality compared to (relatively) younger older adult individuals. Compared with older adults who walked less than 1 km a day, older adults who walked more had better gait quality.

CONCLUSIONS

The walking state, self-reported daily walking amount, and age have a significant effect on the gait quality of older adults. Walking with pigmented sunglasses can be used as a training intervention to improve gait performance. Older adult people who walk less than 1 km/day have worse gait quality compared with their counterparts.

Association of executive function capacity with gait motor imagery ability and PFC activity: An fNIRS study

Individual differences exist in gait motor imagery ability. However, little is known about the underlying neural mechanisms. We previously conducted a study using functional near-infrared spectroscopy (fNIRS), which showed that participants who overestimated mental walking times to a greater degree exhibited greater activation in the right prefrontal cortex (PFC). The PFC is implicated in executive functions (EFs), including working memory (WM). Thus, this study investigated whether individual differences in EF capacity are associated with gait motor imagery ability and PFC activity. Thirty volunteers participated (mean age: 21.7 ± 1.8 years) in the study. Their EF capacity was assessed by the Trail Making Test - Part B (TMT-B). We measured the accuracy of gait motor imagery and PFC activity during mental walking using fNIRS, while changing task difficulty by varying the path width. The results showed that the overestimation of mental walking time over actual walking time and right PFC activity increased with an increase in the TMT-B times. These results suggest that the EF capacity, including WM, is strongly associated with gait motor imagery ability and right PFC activity. The brain network that includes the right PFC may play an important role in the maintenance and manipulation of gait motor imagery.

Mobile Phone Use during Gait: The Role of Perceived Prioritization and Executive Control

(1) Background: Mobile phone use during gait is associated with adverse health outcomes, namely increased risk of pedestrian injury. Healthy individuals can voluntarily prioritize concurrent task performance, but the factors underlying the impact of phone use during walking remain largely unknown. Thus, the objective of this work was to evaluate the relationship between subjective (perceived) prioritization, cognitive flexibility and dual-task performance when using a mobile phone during walking. (2) Methods: Thirty young participants walked for one minute with and without reading or texting on a mobile phone, as well as reading or texting while sitting. Walking performance (kinematics) was recorded, as well as phone use (text comprehension, text read/written), mental workload, perceived prioritization (visual analog scale), and cognitive flexibility (trail-making test). (3) Results: Texting while walking was associated with larger decreases in gait speed, larger gait variability, higher mental workload, and lower text comprehension compared to reading. Perceived prioritization was associated with walking dual-task costs (DTCs) (r = 0.39–0.42, p < 0.04) when texting, and better cognitive flexibility was associated with lower gait DTCs when texting (r = 0.55, p = 0.002) but not reading. (4) Conclusions: The context-dependent link between perceived prioritization, cognitive flexibility, and walking DTCs promotes our understanding of the factors underlying texting-while-walking performance. This could identify individuals who are more prone to dual-task interference in this increasingly common and dangerous task.

Think about it: Cognitive-motor dual-tasking affects sub-regional spine responses to unexpected trunk perturbations

Cognitive motor interference (CMI) is a psychomotor phenomenon characterized by alterations in kinematic spatial-temporal parameters during concurrent cognitive and motor tasks (i.e. dual-tasking). Previous literature has demonstrated that cognitive-motor dual-tasking induces alterations gait parameters; however, the influence of CMI on spine reflexive motion has yet to be researched. The purpose of this study was to assess the influence of cognitive-motor dual-tasking during unexpected spine loading, in particular focusing on paraspinal muscle responses and spine sub-regional kinematic responses. To do this, the spine was perturbed by unexpectedly dropping a 6.8 kg mass into the participants' hands during cognitive dual-task and control conditions. Intersegmental spine angles, paraspinal muscle onset latencies, baseline activations, and response magnitudes were measured. The results demonstrated that participants experienced greater spine flexion at all intersegmental levels during the cognitive dual-task condition compared to the control condition. Additionally, muscle onset latencies were significantly delayed in three of the four paraspinal muscles studied when performing the cognitive-motor dual-task. These results demonstrate that the additional cognitive load led to delayed muscle activation responses and subsequently greater intersegmental lumbar spine flexion in response to a sudden loading perturbation. This suggests that cognitive-motor dual-tasking may increase the risk of developing an acute spine injury under similar conditions.

Between Post-Flâneur and Smartphone Zombie: Smartphone Users’ Altering Visual Attention and Walking Behavior in Public Space

The extensive use of smartphones in our everyday lives has created new modes of appropriation and behavior in public spaces. Recognition of these are essential for urban design and planning practices which help us to improve the relationship between humans, technologies, and urban environment. This study aims to research smartphone users in public space by observing their altering visual attention and walking behavior, and, in this way, to reveal the emergent “new figures”. For this purpose, Korenmarkt square in Ghent, Belgium, was observed for seven days in 10-min time intervals. The gaze and walking behavior of smartphone users were encoded as geo-located and temporal data, analyzed and mapped using statistical and spatial analysis methods. Developing and implementing new methods for identifying the characteristics of smartphone users, this study resulted in a nuanced characterization of novel spatial appropriations. The findings led to a better understanding and knowledge of the different behavior patterns of emergent figures such as “post-flâneurs” and “smartphone zombies” while uncovering their altering visual interactions with and movements in the public space. The results evoked questions on how researchers and designers can make use of spatial analysis methods and rethink the public space of the future as a hybrid construct integrating the virtual and the physical.

Effects of the use of mobile phone on postural and locomotor tasks: a scoping review

BACKGROUND

Using a mobile phone while performing a postural and locomotor tasks is a common, daily situation. Conversing or sending messages (SMS) while walking account for a significant share of accidental injuries. Therefore, understanding the consequences of using a mobile phone on balance and walking is important, all the more so when these postural and locomotor tasks are aggravated by a disease.

RESEARCH QUESTION

Our objective was to conduct a scoping review on the influence of a dual-task situation - generated by the use of mobile phone - on users' postural and/or locomotor tasks.

METHODS

The literature search was conducted in English on PubMed/Medline and CINHAL databases, using keywords associated with postural and locomotor tasks and with the use of mobile phone. Study location, population, number of subjects, experimental design, types of phone use, evaluated postural-locomotor tasks and expected effects were then analyzed.

RESULTS AND SIGNIFICANCE

46 studies were included in this work, 24 of which came from North America. All studies compared postural and locomotor tasks with and without the use of a smartphone. Ten studies also compared at least 2 groups with different characteristics. Only 4 studies included pathological subjects. Various modalities were tested, and most studies focused on walking. Results show that the use of smartphones slows down movement and induces a systematic imbalance, except when listening to music. The dual task of "using the smartphone during a postural or locomotor tasks" induces systematic disturbances of balance and movement, which must be taken into account in the rehabilitation approach. Future studies will have to extend the knowledge regarding pathological situations.

Smartphone-Based Answering to School Subject Questions Alters Gait in Young Digital Natives

Smartphone texting while walking is a very common activity among people of different ages, with the so-called "digital natives" being the category most used to interacting with an electronic device during daily activities, mostly for texting purposes. Previous studies have shown how the concurrency of a smartphone-related task and walking can result in a worsening of stability and an increased risk of injuries for adults; an investigation of whether this effect can be identified also in people of a younger age can improve our understanding of the risks associated with this common activity. In this study, we recruited 29 young adolescents (12 ± 1 years) to test whether walking with a smartphone increases fall and injuries risk, and to quantify this effect. To do so, participants were asked to walk along a walkway, with and without the concurrent writing task on a smartphone; several different parameters linked to stability and risk of fall measures were then calculated from an inertial measurement unit and compared between conditions. Smartphone use determined a reduction of spatio-temporal parameters, including step length (from 0.64 ± 0.08 to 0.55 ± 0.06 m) and gait speed (1.23 ± 0.16 to 0.90 ± 0.16 m/s), and a general worsening of selected indicators of gait stability. This was found to be mostly independent from experience or frequency of use, suggesting that the presence of smartphone activities while walking may determine an increased risk of injury or falls also for a population that grew up being used to this concurrency.