We conducted a study to analyze the unmet needs of and risk factors for use of assistive walking devices by the elderly based on sample survey data from Shanghai, China from July to October 2019. ...Among a total sample size of 11,193 people age 55 and older, 1,947 people (17.39%) needed assistive walking devices, 829 (42.58%) of whom needed but did not use those devices. Multivariate analysis indicated that residence, living alone or cohabitating, indoor handrails, the number of diseases, and IADL were factors influencing the unmet need for assistive walking devices (p < 0.05, respectively). People who lived in community health centers (p = 0.0104, OR = 1.956, 95% CI: 1.171-3.267) and those who lived only with their spouse (p = 0.0002, OR = 2.901, 95% CI: 1.641-5.126) were more likely to have an unmet need for assistive walking devices. People without indoor handrails (p = 0.0481, OR = 0.718, 95% CI: 0.517-0.997), those with 3 or more diseases (p = 0.0008, OR = 0.577, 95% CI: 0.418-0.796), and those with severely impaired IADL (p = 0.0002, OR = 0.139, 95% CI: 0.05-0.386) were less likely to have an unmet need for assistive walking devices. Self-perceived needs of the elderly, the diversity and performance of assistive devices, and the accessibility and affordability of assistive walking devices may lead to unmet needs.
Diabetic patients with foot ulcers are commonly prescribed assistive walking devices to unload the affected foot and promote tissue healing. However, the effect on shear loads to the contralateral ...foot is unknown. This study investigated the effect of a wheeled knee walker (WKW), compared to common devices, on compressive and shear plantar forces carried by the propulsive foot during walking in patients with type 2 diabetes mellitus. A secondary objective investigated plantar forces' correlations with body weight unloaded (BWU).
Participants walked a maximum of 200 m per condition during normal walking or when using crutches, a standard walker, and a WKW in randomized order. Plantar forces were measured with force plates, and wireless force-sensitive pads measured BWU through the hands. The WKW was instrumented to measure BWU onto the seat and handlebars. Three-dimensional motion capture confirmed gait events.
The WKW produced the lowest vertical, braking, propulsive, and medial shear forces but the highest lateral shear force among all conditions. Using crutches or a walker had negligible medial and lateral shear (mean = -6.69 N and -7.80 N), with normal walking producing the highest medial shear. There was a poor relationship between BWU and assistive walking devices and shear force values.
A WKW could be the preferred assistive device for unloading a diabetic foot ulcer. The magnitude of lateral force would need further investigation to determine ulceration risk, given patient susceptibility and neuropathy.
Understanding shear forces on the propulsive foot is important for minimizing contralateral limb tissue damage risk while treating an ulcer. Different assistive walking devices change walking patterns and affect shear forces on the plantar surface of the foot. Although the WKW minimizes several loading metrics, a clinical trial investigating assistive walking device compliance and wound healing in diabetic foot ulcer patients across devices is needed.
Near‐infrared (NIR) light‐driven bilayer actuators capable of fast, highly efficient, and reversible bending/unbending motions toward periodic NIR light irradiation are fabricated by exploiting the ...photothermal conversion and humidity‐sensitive properties of polydopamine‐modified reduced graphene oxide (PDA‐RGO). The bilayer actuator comprises a PDA‐RGO layer prepared by a filtration method, and this layer is subsequently spin‐coated with a layer of UV‐cured Norland Optical Adhesive (NOA)‐63. Given the hydrophilicity of PDA, the PDA‐RGO layer can absorb water to swell and lose water to shrink. The intrinsic NIR absorbance of RGO sheets convertes NIR light into thermal energy, which transfers the humidity‐responsive PDA‐RGO layer to be NIR light‐responsive. Considering that the shape of the NOA‐63 layer remains unchanged under NIR light, periodic NIR light irradiation leads to asymmetric shrinkage/expansion of the bilayer, which enables fast and reversible bending/unbending motions of the bilayer actuator. We demonstrate that compared with a poly(ethylenimine)‐modified graphene oxide layer, the PDA‐RGO layer is unique in fabricating highly efficient bilayer actuators. A NIR light‐driven walking device capable of performing quick worm‐like motion on a ratchet substrate is built by connecting two polyethylene terephthalate plates as claws on opposite ends of the PDA‐RGO/NOA‐63 bilayer actuator.
Near‐infrared (NIR) light‐driven bilayer actuators are fabricated by exploiting the photothermal conversion and humidity‐sensitive properties of polydopamine‐modified reduced graphene oxide. The bilayer actuator is capable of fast, highly efficient, and reversible bending/unbending motions toward periodic NIR light irradiation. The bilayer actuator is also utilized to build a NIR light‐driven walking device capable of performing quick worm‐like motion.
We conducted a study to analyze the unmet needs of and risk factors for use of assistive walking devices by the elderly based on sample survey data from Shanghai, China from July to October 2019. ...Among a total sample size of 11,193 people age 55 and older, 1,947 people (17.39%) needed assistive walking devices, 829 (42.58%) of whom needed but did not use those devices. Multivariate analysis indicated that residence, living alone or cohabitating, indoor handrails, the number of diseases, and IADL were factors influencing the unmet need for assistive walking devices (p < 0.05, respectively). People who lived in community health centers (p = 0.0104, OR = 1.956, 95% CI: 1.171-3.267) and those who lived only with their spouse (p = 0.0002, OR = 2.901, 95% CI: 1.641-5.126) were more likely to have an unmet need for assistive walking devices. People without indoor handrails (p = 0.0481, OR = 0.718, 95% CI: 0.517-0.997), those with 3 or more diseases (p = 0.0008, OR = 0.577, 95% CI: 0.418-0.796), and those with severely impaired IADL (p = 0.0002, OR = 0.139, 95% CI: 0.05-0.386) were less likely to have an unmet need for assistive walking devices. Self-perceived needs of the elderly, the diversity and performance of assistive devices, and the accessibility and affordability of assistive walking devices may lead to unmet needs.
Robotic walking devices (RWD) have shown many physical benefits in Spinal Cord Injury (SCI) rehabilitation. No study to date has explored end-user perceptions of these devices or gained insight into ...the use of these devices in a gym-based setting.
This preliminary study explores the perspectives of four non-ambulatory individuals with SCI on using an exoskeleton walking device in a gym-based community setting.
In-depth, semi-structured interviews were conducted with four SCI individuals living in the community. Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis established common overarching themes and subthemes.
Four primary themes emerged addressing "The Psychological Adjustments Around Using RWDs with Respect to Disability", "Perceived Physical, Social and Psychological Benefits of Using an Exoskeleton", "The Role of External Influences", and "A Wellness Model to Health". A fully integrated gym setting was found to provide a positive and encouraging space to utilise the device. In addition, both the ability to set training goals and the positive attitude of robotic trainers were deemed to be important factors.
This preliminary study provides detailed perspectives of four non-ambulatory individuals with SCI on utilising an exoskeleton walking device in a community setting. It suggests that gym-based RWDs impact positively on the users' lives and enhance their perceived wellbeing and sense of community integration. Enabling access to similar, community-based facilities should be prioritised for those with longstanding SCI disability.
Summary Objectives (1) Test the hypothesis that walking poles decrease the external knee adduction moment during gait in patients with varus gonarthrosis, and (2) explore potential mechanisms. Design ...Thirty-four patients with medial compartment knee osteoarthritis (OA) and varus alignment underwent three dimensional (3D) gait analysis with and without using walking poles. Conditions were randomized and walking speed was maintained ±5% of the self-selected speed of the initial condition. The pole held in the hand of the unaffected side was instrumented with a compression load cell. Results Student's t tests for paired samples indicated small but statistically significant increases ( P < 0.001) in knee adduction moment (calculated from inverse dynamics) for its first peak, second peak and angular impulse when using the poles; mean increases (95% confidence interval – CI) were 0.17%BW*Ht (0.08, 0.27), 0.17%BW*Ht (0.04, 0.30) and 0.15%BW*Ht*s (0.09, 0.22), respectively. There was a decrease ( P = 0.015) in vertical ground reaction force (−0.02 BW (−0.04, −0.01)), yet increase ( P < 0.001) in its frontal plane lever arm about the knee (0.30 cm (0.15, 0.44)), at the time of the first peak knee adduction moment. Pole force in the vertical direction was inversely related ( r = −0.34, P = 0.05) to the increase in first peak adduction moment. Conclusion Although results are variable among patients, and may be related to individual technique, these overall findings suggest that walking poles do not decrease knee adduction moments, and therefore likely do not decrease medial compartment loads, in patients with varus gonarthrosis. Decreases in knee joint loading should not be used as rationale for walking pole use in these patients.
The efficacy of assistive devices used during walking is often measured as a reduction in metabolic cost. Metabolic cost is typically assessed within a day or on multiple days, yet the benefit of ...performing within-day vs. between-day metabolic assessments is unknown. The purpose of this study was to determine the within-day minimal detectable change of standard measures of physiologic performance using a conventional portable metabolic system (K4b
2
Cosmed, Rome, Italy), and compare these to between-day values. Twenty healthy adults completed two identical data collection sessions on separate days. In each session they performed three bouts of treadmill walking interspersed with three bouts of rest while oxygen consumption (
), carbon dioxide production, and heart rate were measured. Intraclass correlation coefficients (ICC) and minimal detectable change values were calculated for non-resting within-day, as well as all between-day comparisons. All within-day measures were clinically reliable (ICC > 0.96), while between-day measures were generally less reliable (ICCs > 0.82). Within-day minimal detectable change values (walking heart rate = 4.9 bpm; gross
= 0.80 mL/kg/min; net
= 0.80 mL/kg/min; cost of transport = 0.022 J/Nm) were about half as large as between-day values. The results of this study suggest that, where possible, physiologic changes should be assessed within a single day of testing to maximize ability to detect small changes in performance.
The gait patterns of stroke survivors become slow and metabolically inefficient as a result of muscle weakness and low weight-bearing capacity. Exoskeletons and assistive robots can improve gait ...kinematics and energetics. However, the use of these powered devices may cause a reliance on the device itself that results in limited lasting improvement of the paretic leg function. Specifically, there exists a need to strengthen and train the response of weak ankle muscles, such as the soleus muscle, in stroke survivors. Impaired activation of the soleus muscle induces unnatural gait kinematics and reduced propulsion. The mechanical modulation of the soleus muscle can improve its loading response and enhance gait performance after a stroke. This paper develops a closed-loop feedback controller to manipulate the ankle joint dynamics to mechanically control the soleus muscle response using a motorized ankle orthosis. The control method is inspired by backstepping control techniques and developed to connect the ankle joint angular velocity and the soleus muscle response during the stance phase of walking. The tracking objective is quantified using an integral-like muscle error between the desired soleus response and the actual muscle response, which is measurable using surface electromyography (EMG). The closed-loop electric motor controller is designed to apply ankle perturbations exploiting the backstepping error and an adaptive control term to cope with uncertain parameters that satisfy the linear-in-the-parameters property. A switching signal is developed using heel and toe ground reaction forces to strategically perturb the ankle and target the soleus muscle loading response in real-time during the mid-late stance phase of walking. A Lyapunov-based stability analysis is used to guarantee a globally uniformly ultimately bounded (GUUB) tracking result.
Older persons are typically classified as “users” or “nonusers” of walking devices. Little is known about their experience of maintaining proximity to the walking device or the consistency with which ...they use it. The authors addressed those gaps in this longitudinal, phenomenological study with 40 women (aged 85-98). With regard to maintaining proximity to the device, the experience was structured by “keeping track of my cane,” “keeping the cane handy,” “transitioning between keeping track of the cane and keeping it handy,” and “keeping the walker handy so I can use it.” Despite stated intentions to the contrary, few women consistently walked with a device. The experience was characterized by “walking with it unless . . . ” and “judging whether I need it to walk in this situation.” Rather than assuming that clients use a cane or walker consistently, practitioners should explore intentions to maintain proximity to it and individualize interventions accordingly.
Background/Objectives: To evaluate factors related to the ability of ambulatory patients with spinal cord injury (SCI) to walk over small obstacles.
Study Design: Cross-sectional study.
Methods: ...Thirty-four patients with SCI (ASIA impairment scale AIS D) who were able to walk independently at least 10 m with or without walking devices were recruited for the study. Participants were required to walk over small obstacles (1,4, and 8 cm in height or width; total of 6 conditions). A "fail" was recorded when either the lower limbs or the walking device contacted the obstacle. Multiple logistic regression models were applied to determine the effects of walking devices (presence or absence), SCI levels (tetraparesis or paraparesis), and SCI stages (acute or chronic) on the ability of obstacle crossing.
Results: Fifteen participants (44%) failed to adequately clear the foot or walking device over obstacles in at least one condition (range 1-3 conditions). After adjusting for covariates, the chance of failure on obstacle crossing was greatly increased with the use of walking devices (odds ratio = 8.50; 95% CI = 0.85−75.03)
Conclusions: Gait safety in independent ambulatory participants with SCI remains threatened. Participants who walked with walking devices encountered a greater chance of failing to walk over obstacles as a result of inefficiently moving the foot or walking device over small obstacles. Thus, instead of training in an empty/ quiet room, rehabilitation procedures should incorporate contextual conditions that patients encounter at home and in the community in order to minimize risk of injury and prepare patients to be more independent after discharge.
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