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Pîrșcoveanu CI, Hansen EA, Franch J, Madeleine P. Walking against the odds: The intricate connection between spatiotemporal characteristics, kinetic and kinematic variables, cognitive stress, and passive assistive exoskeletons in senior and young adults. Hum Mov Sci 2024; 97:103268. [PMID: 39128412 DOI: 10.1016/j.humov.2024.103268] [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: 01/05/2024] [Revised: 06/19/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024]
Abstract
In this study, we investigated the combined effects of age, dual-tasking (DT) and a passive hip exoskeleton on gait patterns among senior (SA) and young adults (YA). It was hypothesized that SA will be more affected by DT and that wearing the exoskeleton will improve gait patterns for both groups during DT. Twenty-two SA and twenty-six YA performed a single task (normal walking) and DT walking at their preferred speed with an exoskeleton (EXO), without (noEXO), and a sham version (SHAM) in a randomized and balanced order. Speed, cadence, double support time (DST), step length, hip joint power, range of motion (ROM), and moments (mom), as well as DT performance, were extracted using mocap, force plates (1000 Hz), and a voice recorder. Three-way MANOVA with group × device × condition was conducted (p < .05, inferred significance). Results showed a predominantly significant main effect of group for step length, speed, DST, ROM, and mom (p ≤ .01), main effect of condition for cadence, DST, speed, and mom (p < .01) and a main effect of the device for ROMz and mom (p < .05). Age-related changes were seen by decreased walking speed and step length, independent of DT and use of exoskeleton. Wearing the EXO aided the SA group to maintain similar levels of cadence from single to DT and decreased the hip internal rotation mom by 65%. There was no difference in DT performance between groups. In conclusion, SA showed a decline in gait patterns during DT that was somewhat mitigated by wearing an EXO.
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Affiliation(s)
- Cristina-Ioana Pîrșcoveanu
- Aalborg University, Faculty of Medicine, Department of Health Science and Technology, ExerciseTech, Aalborg, Denmark.
| | - Ernst Albin Hansen
- University College Absalon, Centre for Health and Rehabilitation, Slagelse, Denmark
| | - Jesper Franch
- Aalborg University, Faculty of Medicine, Department of Health Science and Technology, ExerciseTech, Aalborg, Denmark
| | - Pascal Madeleine
- Aalborg University, Faculty of Medicine, Department of Health Science and Technology, ExerciseTech, Aalborg, Denmark
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Tong CY, Zhu RTL, Ling YT, Scheeren EM, Lam FMH, Fu H, Ma CZH. Muscular and Kinematic Responses to Unexpected Translational Balance Perturbation: A Pilot Study in Healthy Young Adults. Bioengineering (Basel) 2023; 10:831. [PMID: 37508858 PMCID: PMC10376184 DOI: 10.3390/bioengineering10070831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Falls and fall-related injuries are significant public health problems in older adults. While balance-controlling strategies have been extensively researched, there is still a lack of understanding regarding how fast the lower-limb muscles contract and coordinate in response to a sudden loss of standing balance. Therefore, this pilot study aims to investigate the speed and timing patterns of multiple joint/muscles' activities among the different challenges in standing balance. Twelve healthy young subjects were recruited, and they received unexpected translational balance perturbations with randomized intensities and directions. Electromyographical (EMG) and mechanomyographical (MMG) signals of eight dominant-leg's muscles, dominant-leg's three-dimensional (3D) hip/knee/ankle joint angles, and 3D postural sways were concurrently collected. Two-way ANOVAs were used to examine the difference in timing and speed of the collected signals among muscles/joint motions and among perturbation intensities. This study has found that (1) agonist muscles resisting the induced postural sway tended to activate more rapidly than the antagonist muscles, and ankle muscles contributed the most with the fastest rate of response; (2) voluntary corrective lower-limb joint motions and postural sways could occur as early as the perturbation-induced passive ones; (3) muscles reacted more rapidly under a larger perturbation intensity, while the joint motions or postural sways did not. These findings expand the current knowledge on standing-balance-controlling mechanisms and may potentially provide more insights for developing future fall-prevention strategies in daily life.
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Affiliation(s)
- Cheuk Ying Tong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Ringo Tang-Long Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Centre for Developmental Neurobiology, King's College London, London SE1 1UL, UK
| | - Eduardo Mendonça Scheeren
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Brazil
| | - Freddy Man Hin Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Hong Fu
- Department of Mathematics and Information Technology, The Education University of Hong Kong, Hong Kong SAR 999077, China
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
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Ma CZH, Bao T, DiCesare CA, Harris I, Chambers A, Shull PB, Zheng YP, Cham R, Sienko KH. Reducing Slip Risk: A Feasibility Study of Gait Training with Semi-Real-Time Feedback of Foot-Floor Contact Angle. SENSORS (BASEL, SWITZERLAND) 2022; 22:3641. [PMID: 35632054 PMCID: PMC9144019 DOI: 10.3390/s22103641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Slip-induced falls, responsible for approximately 40% of falls, can lead to severe injuries and in extreme cases, death. A large foot-floor contact angle (FFCA) during the heel-strike event has been associated with an increased risk of slip-induced falls. The goals of this feasibility study were to design and assess a method for detecting FFCA and providing cues to the user to generate a compensatory FFCA response during a future heel-strike event. The long-term goal of this research is to train gait in order to minimize the likelihood of a slip event due to a large FFCA. An inertial measurement unit (IMU) was used to estimate FFCA, and a speaker provided auditory semi-real-time feedback when the FFCA was outside of a 10-20 degree target range following a heel-strike event. In addition to training with the FFCA feedback during a 10-min treadmill training period, the healthy young participants completed pre- and post-training overground walking trials. Results showed that training with FFCA feedback increased FFCA events within the target range by 16% for "high-risk" walkers (i.e., participants that walked with more than 75% of their FFCAs outside the target range) both during feedback treadmill trials and post-training overground trials without feedback, supporting the feasibility of training FFCA using a semi-real-time FFCA feedback system.
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Affiliation(s)
- Christina Zong-Hao Ma
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Tian Bao
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Christopher A. DiCesare
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Isaac Harris
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - April Chambers
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Peter B. Shull
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
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Bosnic M, Rasoulian A, Brandon S. Investigating the Effects of Activation State and Location on Lower Limb Tissue Stiffness. J Biomech 2022; 135:111032. [DOI: 10.1016/j.jbiomech.2022.111032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/12/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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Ma CZH, Lam WK, Chang BC, Lee WCC. Can Insoles Be Used to Improve Static and Dynamic Balance of Community-Dwelling Older Adults? A Systematic Review on Recent Advances and Future Perspectives. J Aging Phys Act 2020; 28:971-986. [PMID: 32498037 DOI: 10.1123/japa.2019-0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022]
Abstract
This systematic review investigated the effects of orthopedic, vibrating, and textured insoles on the postural balance of community-dwelling older adults. Articles published in English from 1999 to 2019 investigating the effects of (a) orthopedic, (b) vibrating, and (c) textured insoles on static and dynamic balance in community-dwelling older adults were considered. Twenty-four trials with a total of 634 older adults were identified. The information gathered generally supported the balance-improving effects of orthopedic, vibrating, and textured insoles in both static and dynamic conditions among community-dwelling older adults. Further examination found that rigidity, texture patterns, vibration thresholds, and components like arch supports and heel cups are important factors in determining whether insoles can improve balance. This review highlights the potential of insoles for improving the static and dynamic balance of community-dwelling older adults. Good knowledge in insole designs and an understanding of medical conditions of older adults are required when attempts are made to improve postural balance using insoles.
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Jellema AH, Huysmans T, Hartholt K, van der Cammen TJM. Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear. Maturitas 2019; 127:64-81. [PMID: 31351522 DOI: 10.1016/j.maturitas.2019.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/01/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort and reduced mobility. A review of the literature was performed in Medline, Scopus and Embase with three aims: (a) to evaluate the effects of shoes or shoe elements on the comfort and mobility of older adults, (b) to summarise the evidence-based elements of a safe and comfortable shoe for older adults, and (c) from that, to compile those elements into design recommendations for a safe and comfortable shoe for older adults. Safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. We conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people. The shoe market should increase the availability of well-fitting shoes designed for the older foot and person.
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Affiliation(s)
- Anton H Jellema
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands.
| | - Toon Huysmans
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Klaas Hartholt
- Reinier de Graaf Hospital, Department of General Surgery, Delft, the Netherlands
| | - Tischa J M van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands; Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Ma CZH, Ling YT, Shea QTK, Wang LK, Wang XY, Zheng YP. Towards Wearable Comprehensive Capture and Analysis of Skeletal Muscle Activity during Human Locomotion. SENSORS 2019; 19:s19010195. [PMID: 30621103 PMCID: PMC6339139 DOI: 10.3390/s19010195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/22/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022]
Abstract
Background: Motion capture and analyzing systems are essential for understanding locomotion. However, the existing devices are too cumbersome and can be used indoors only. A newly-developed wearable motion capture and measurement system with multiple sensors and ultrasound imaging was introduced in this study. Methods: In ten healthy participants, the changes in muscle area and activity of gastrocnemius, plantarflexion and dorsiflexion of right leg during walking were evaluated by the developed system and the Vicon system. The existence of significant changes in a gait cycle, comparison of the ankle kinetic data captured by the developed system and the Vicon system, and test-retest reliability (evaluated by the intraclass correlation coefficient, ICC) in each channel’s data captured by the developed system were examined. Results: Moderate to good test-retest reliability of various channels of the developed system (0.512 ≤ ICC ≤ 0.988, p < 0.05), significantly high correlation between the developed system and Vicon system in ankle joint angles (0.638R ≤ 0.707, p < 0.05), and significant changes in muscle activity of gastrocnemius during a gait cycle (p < 0.05) were found. Conclusion: A newly developed wearable motion capture and measurement system with ultrasound imaging that can accurately capture the motion of one leg was evaluated in this study, which paves the way towards real-time comprehensive evaluation of muscles and joint motions during different activities in both indoor and outdoor environments.
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Affiliation(s)
- Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Department of Rehabilitation, Jönköping University, 551 11 Jönköping, Sweden.
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Queenie Tsung Kwan Shea
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Li-Ke Wang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Xiao-Yun Wang
- Guangdong Work Injury Rehabilitation Center, Guangzhou 510440, China.
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
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Development of a Universal Design-Based Guide for Handrails: An Empirical Study for Hong Kong Elderly. SUSTAINABILITY 2018. [DOI: 10.3390/su10114233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An important and basic strategy for facilitating the inclusion and daily life of elderly in accordance with those living in public rental housing buildings is to allow their circulation to be barrier-free and self-supported. Therefore, the provision of a handrail guide could improve their living standard. This paper develops a universal design guide for handrails focusing on the needs of elderly. Fifteen routes with mostly elderly were selected and targeted for evaluating the existing problems with handrail provision. Surveys and informal interviews with elderly, adults, and children were also conducted to further investigate their needs, their ease of existing facilities, and possible future implementation to improve their ease. From the survey results, it was found that most of the existing problems with handrail layouts exist within the community. In addition to standardizing, modifying, and suggesting the ideas on handrail design and layout, the promotion of the ideas from universal design was the emphasis on this investigation in order to make a barrier-free city into a barrier-free but universal community for a better international city. The guide focuses on the standardization of synthetization of the scope in terms of design and layout. Simultaneously, an advanced part of design also regards the improvement of technological, environmental, and self-support features to improve Hong Kong’s international friendliness with tailor-made ideas such as Elderlysteady.
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