Indoor Mobility Research Articles

高齢者の生活機能・障害と居住環境の関連性に関する調査研究 : 住生活に着目した居住環境評価尺度の開発

This research explored constituting factors, examining their reliability and validity, to develop a general residential environment assessment measure, recognizing the importance of the elderly's dwelling life. Residential environments were categorized into health, efficiency, safety and belonging. Factor analysis results indicated the following in each category: health -"peripheral environments," "temperature and humidity environments," "indoor environments," efficiency-"integrated composition centering around the living room," "bathing" "eating" "wash-up," "mobility," "toileting," safety - "indoor mobility" "indoor mobility with variations" "room lighting" "emergency" belonging - "ownership," "attachment," "privacy." This was found to be a useful assessment measure of residential environments, considering the examination of reliability and validity.

The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement.

To determine whether residual difficulty in functioning in spite of equipment use is linked with increased use of personal assistance. Longitudinal. Two waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) database were used to test the effect of residual difficulty on hours of personal assistance and bed days at Wave 1 on hours of personal assistance, bed days, and nursing home placement at Waves 1 and 2. A nationally representative setting of community-dwelling persons aged 70 and older and their spouses, regardless of age at Wave 1 AHEAD. There was movement of some respondents into nursing homes by the Wave 2 interview. Respondents to the AHEAD survey, N=8,222 at Wave 1. The dependent variables were hours of personal assistance in the month before the AHEAD survey (Waves 1 and 2), number of days in month before the survey in which the person did not get out of bed (Waves 1 and 2), and residence in a nursing home at Wave 2. The key explanatory variable was a mutually exclusive (four category) variable that specified whether there was residual difficulty (yes/no) in indoor mobility in spite of using equipment to aid specifically with indoor mobility. The four-category variable was defined by the four categories created by a cross-tabulation of equipment use (yes/no) and difficulty with indoor mobility (yes/no). A similar four-category variable was also defined for transferring in the home. In cross section, equipment users with residual difficulty reported more hours of personal assistance in the case of indoor mobility impairment and were more likely to have some hours of personal assistance than those without residual difficulty with indoor mobility and transferring. Longitudinally, those with residual difficulty at Wave 1 were more likely to need some personal assistance hours at Wave 2 (odds ratio=1.67, 95% confidence interval= 1.23-2.26 for indoor mobility). For transferring, those with residual difficulty had 43 more hours of personal assistance per month (P=.001) than those for whom equipment resolved their disability. Residual disability was linked to more bed days for users of indoor mobility and transferring equipment, but it was not predictive of nursing home placement by Wave 2. Equipment for indoor mobility or transfers apparently resolves difficulty for some users of the equipment but not for others. Residual task difficulty in spite of equipment for indoor mobility and transferring is linked with worse outcomes, including increased dependency on personal assistance and more days in bed. This shows that more attention is needed to determine whether equipment prescribed is appropriate for a patient's difficulty and that follow-up assessment is crucial after equipment is prescribed.

Vision and mobility performance of subjects with age-related macular degeneration.

To investigate the effects of age-related macular degeneration (ARMD) on mobility performance and to identify the vision determinants of mobility in subjects with ARMD. Walking speed and the number of obstacle contacts made on a 79-m indoor mobility course were measured in 21 subjects with ARMD and 11 age-matched subjects with normal vision. The mobility measures were transformed to percentage preferred walking speed and contacts score. The vision functions assessed included binocular visual acuity, contrast sensitivity, and visual field. In this study, subjects with ARMD did not walk significantly slower or make significantly more obstacle contacts on the mobility course than the normally sighted subjects of similar age. Between 29% and 35% of the variance in the ARMD mobility performance was accounted for by visual field and contrast sensitivity measures. The most significant predictor of mobility performance scored as percentage preferred walking speed was the size of a binocular central scotoma. As the size of a binocular central scotoma increases, mobility performance decreases.

Neuromuscular stimulation of the quadriceps muscle after hip fracture: A randomized controlled trial

Lamb SE, Oldham JA, Morse RE, Evans JG. Neuromuscular stimulation of the quadriceps muscle after hip fracture: a randomized controlled trial. Arch Phys Med Rehabil 2002;83;1087-92. Objective: To study the feasibility and effect of neuromuscular stimulation on recovery of mobility after surgical fixation for hip fracture. Design: Double-blind study with stratified randomization. Setting: Home-based rehabilitation program. Participants: Twenty-four women over the age of 75 years with hip fracture. Interventions: Neuromuscular or placebo stimulation of the quadriceps muscle of the fractured leg, applied for 3 hours a day, for 6 weeks, commencing 1 week after surgery. Main Outcome Measures: Recovery of walking speed and ability, postural stability, lower-limb muscle power, and pain at 7 and 13 weeks after surgery. Results: Women in the neuromuscular stimulation group showed faster recovery of mobility. Of the women receiving stimulation, 9 of 12 recovered their prior levels of indoor mobility ability by 13 weeks compared with 3 of 12 in the placebo group (Fisher exact test, P=.046). There were no differences in recovery of walking speed in the first 7 weeks, but women in the stimulation group had greater recovery between 7 and 13 weeks (mean difference=−.13m/s; 95% confidence interval, −.23 to −.01). Conclusions: Neuromuscular stimulation at home is feasible and may be effective in speeding recovery of mobility after surgical fixation of hip fracture. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Hard tech, soft touch: Technology to aid indoor mobility and transfer of immobilized patients

Hard tech, soft touch: Technology to aid indoor mobility and transfer of immobilized patients

Older People and Mobility in the Home: in Search of Useful Assistive Technologies

A number of assistive technologies exist to help older people with their indoor mobility needs and there is an increasing recognition that older people are capable of being critical and active consumers of these technologies. This paper reports on a study that used focus groups and informal trials to explore older people's perspectives on their indoor mobility problems, their ideas on what assistive technologies might resolve these problems and their evaluation of assistive technologies that were developed in response to these ideas. The analysis of the results from the four focus groups led to the development of a stair-climbing aid and a new cataloguing aid. The analysis of the results from the informal trials produced useful feedback on the design of the two products and indicated some limitations to the focus group methodology which could be addressed in future research.

Mobility modeling and traffic analysis in three-dimensional high-rise building environments

To efficiently plan future personal communications services, we need to solve various mobility/traffic problems in one-dimensional (1-D), two-dimensional (2-D), and three-dimensional (3-D) micro- or pico-cell environments. Although many users exhibit vertical motion inside elevators in high-rise buildings, there have been no studies regarding cell planning which take into account vertical motion with elevators. We extend the previous 3-D indoor mobility modeling by considering the proper boundary conditions on each floor and vertical motions through elevators and modeling mobility in high-rise buildings in order to estimate the number of handoffs. We then propose a blocking probability model with mobility as a traffic model in 3-D indoor environments. Using this model, we can obtain the required number of channels per cell under the given blocking probability constraint. These results can be used in planning the networks of future personal communications services.

Preventing Falls: To Modify the Environment or the Individual?

Preventing Falls: To Modify the Environment or the Individual?

The process of stroke rehabilitation: what happens and why.

To assess the process of hospital-based stroke rehabilitation. A criterion-based process audit, combined with surveys of patient and staff opinions and basic outcome measures. All wards and units treating stroke patients in a health care district, including an acute and a community National Health Service (NHS) trust. Process audit: documented notes of 115 stroke patients admitted over a four-month period. Patient satisfaction survey: 93 surviving stroke patients. Staff opinion survey: Hospital doctors, therapists and nurses treating stroke patients throughout the district. A disappointingly poor level of service. The main shortcomings were poor assessment of impairment (pass rate, 46%), inadequate communication between staff and with patients and carers (pass rate, 43%), and an absence of rehabilitation beyond the basic of activities of daily living and indoor mobility (pass rate for assessment of disability and emotional need, 50%). Thirty-three per cent of patients were dissatisfied with the hospital-based service they received, particularly lack of therapy, information and recovery. The main reasons for these shortcomings were low priority given to stroke patients, lack of time, shortage of staff, and lack of knowledge and awareness of stroke amongst the staff. Rehabilitation units and elderly care tended to perform better than general medical units in areas of assessment of impairment, self-care skills and mobility, and wheelchair provision. Evidence from previous publications suggests that this service was no worse than in other districts, but this audit methodology, by comprehensively examining many aspects of a service together, is better able to reveal inadequacies.

Orientation and mobility in age-related macular degeneration

This study investigated the orientation and mobility (O&M) performance of subjects with age-related macular degeneration (ARMD). Mobility performance, assessed as walking speed, percentage preferred walking speed (PPWS), and number of contacts with obstacles, was measured on 21 subjects with ARMD and 11 age-matched controls using a 79-meter indoor mobility course. Orientation was assessed by asking subjects to perform two tasks. Similar trends were found for results using walking speed and PPWS, except that age had a significant effect on walking speed. No significant difference in mobility performance was found between ARMD and control subjects. Reduced illumination resulted in worse mobility performance by both subject groups. Language: en

CHANGES IN THE QUALITY OF LIFE OF HEMIPLEGIC STROKE PATIENTS WITH TIME

To evaluate the influence of time on the quality of life of hemiplegic stroke patients living at home, we analyzed a sample of 45 outpatients. The sample was divided into two groups, according to the delay between the discharge time from hospital and the assessment (Group 1, fewer than 6 mo; Group 2, more than 6 mo after discharge). We hypothesized that patients in Group 2 would have a lower level of quality of life than patients in Group 1. Disability was assessed with the Functional Independence Measure, and the quality of life was assessed with the Reintegration to Normal Living Index. Both groups were comparable with regard to demographic and stroke characteristics. There was no statistically significant difference in Functional Independence Measure scores (global and subscales). Reintegration to Normal Living Index-perception of self subscale scores were significantly lower in Group 2. At the item level, quality of life scores were also significantly lower in Group 2 for indoor mobility (Mann-Whitney U test; P = 0.001), self-care needs (P = 0.005), personal relationships (P = 0.02), and the handling of life events (P = 0.05). These results confirm our hypothesis and suggest that quality of life may deteriorate in some domains over time, even when the disability level is unchanged, but these results need to be replicated in prospective studies with larger samples of stroke survivors.

Estimating total Barthel scores from just three items: the European Stroke Database ‘minimum dataset’ for assessing functional status at discharge from hospital

The European Stroke Database (ESDB) Project aims to develop a 'common clinical language' for stroke care by agreeing on terminology, definitions and clinical assessments. Each area of stroke assessment has a 'minimum dataset', which can be collected routinely and more detailed information can be added for particular studies. Measurement of patients' functional status at discharge is essential for assessing the impact of hospital care, but even simple activities of daily living scales like the Barthel index may not be easy to use routinely on busy acute units. We thus aimed to further simplify the 20-point Barthel index by reducing it to a few key items. We initially analysed data on 169 consecutive stroke patients discharged from one British hospital and found that a simple formula involving the combined subscores for urinary continence (Blad), bed-chair transfers C (Trans) and indoor mobility (Mob)-(Blad + Trans + Mob) x 2.39 + 0.14-predicted the total BI score to within 1 point in 79% and to within 2 points in 95% of cases. We then tested this three-item Barthel index (BI3) in four different stroke datasets (total n = 824). The predictions were accurate to +/-1 point in 72-81% and to +/-2 points in 88-97% of cases, and BI3 accounted for 95% of the variance in total Barthel score. It was more accurate in patients without obvious mental impairment. For studies involving large groups of stroke patients, it is sufficient to know about each patient's continence, transfers and indoor mobility at discharge, in order to estimate the total Barthel score. These measures have therefore been incorporated, together with a simple observational measure of cognitive status, into the database minimum dataset for short-term functional outcome and are now being validated in international studies.

Mobility performance with retinitis pigmentosa

Purpose: Reduced mobility can have a serious impact on quality of life. Though previous studies have demonstrated that some vision measures relate to the mobility of subjects with simulated and true low vision, the relationship between residual vision and mobility is not clear. We investigated the relationship between clinical vision measures and mobility performance under different illumination levels for subjects with retinitis pigmentosa (RP). Methods: Binocular visual acuities, letter contrast sensitivities and static central threshold visual fields were measured on 10 subjects with RP and nine age‐matched control subjects. Mobility performance was measured on an indoor mobility course at high and low illuminances and was assessed by percentage preferred walking speed (PPWS) and number of errors. Results: The RP group showed significantly reduced PPWS and greater numbers of errors than the control group. The reduction in illumination resulted in significantly worse error and PPWS scores. Unlike the control group, the presence of a glare source did not reduce the PPWS of the RP group under high illumination. Multiple regression analyses showed that the average visual field extent was the most significant predictor of mobility; letter contrast sensitivity and visual acuity added to the regression models for the low illumination measures to account for up to 75 per cent of the variation in mobility performance. Conclusions: People with RP have worse mobility than people with normal vision, more so under reduced illumination levels. Visual field extent was the strongest predictor of mobility performance. (Clin Exp Optom 1996; 80: 1: 1–12)

Quality of Life in Rehabilitated Lower Limb Amputees

Group differences in the overall RNL score were found to be statistically significant in favour of the 1PoP group ( P < 0.05,. Of t h e 11 statements in the RNL index the difference between the two groups was most evident in statements regarding comfort in self-care needs, recreational activities, and self-confidence. Responses indicated that while 77.784. 66.676 and 66.67'k in the [POP p u p stated satisfaction (mre 2 in survey scale); thew percentages were 28.57. 38.10 and 28.57 respectively in the aecond group. Both p u p s reported normal aatisfaction in indoor mobility, dissatisfaction in mohility on trips. and moderate impairment in social activities. We examined the impact of several variables on the RNL x o r e and found phantom limb as the only variable to reduce significantly the overall score in the Becond group tP < 0.06).

Sonar sensing for low-cost indoor mobility

Abstract Low-cost autonomous mobility poses an important challenge on the way to new robot applications. Ultrasonic sensor systems are both robust and low-cost. We therefore have investigated the usefulness of several types of ultrasonic sensor principles for obstacle avoidance and localisation. Our experiments show that by tailoring the algorithms to the specific sensing task at hand, autonomous mobility can to a wide extent be achieved with a simple monaural system. However, some drawbacks like limited speed and resolution in map building remain. These drawbacks can be overcome by more advanced ultrasonic sensor systems, where two or three receivers instead of one are used in order to get more data from one single measurement.

Muscle strength and mobility as predictors of survival in 75-84-year-old people.

The purpose of the study was to examine the association of physical capacity, as determined on the basis of self-report and physical measurements, with survival in three groups of elderly people aged 75, 80 and 75-84 years. The main aspects of physical capacity were mobility, walking speed, hand grip strength and knee extension strength. Although 1142 persons participated in mobility interview, of whom 466 also took part in the walking speed test, and 463 in the strength tests. The follow-up periods ranged from 48 to 58 months. Risk of death was significantly related to difficulties in indoor mobility among the 75-84-year-olds (odds ratio = 1.99, 95% confidence interval = 1.27-3.13) and 75- and 80- year-olds (OR = 1.60, CI = 1.07-2.38) and outdoor mobility among the 75-84-year-olds (OR = 2.44, CI = 1.63-3.67) and 75- and 80-year-olds (OR =2.75, CI = 1.72-4.40). The odds ratios for hand grip strength (OR = 1.86, CI=1.13-3.07), knee extension strength (OR =2.52, CI = 1.50-4.42) and walking time over 10 meters (OR = 1.98, CI = 1.18-3.34) for the 75- and 80-year-olds were also significant. Since these variables can be easily measured and provide valuable information about functional capacity and risk of death they merit inclusion in medical examination of elderly clients.

THE DEVELOPMENT OF PROGRAMMED INSTRUCTION IN ORIENTATION AND MOBILITY FOR AGED BLIND ADULTS

The ability to move about safely and independently is regarded as a basic tenet of our society. For many aged visually impaired persons (VIPs), however, the ability to move about safely and independently is often limited, or may not exist at all. Vision loss, concomitant with other sensory and physical deficits, may be the deciding factor for the aged VIP to remain sedentary. Yet loss of vision need not be viewed synonymously with loss of mobility. Remaining an independent and safe traveler with vision loss is a challenge, but it is also an attainable goal. This article presents information that describes the results of a unique project designed to qualitatively increase the aged VIP's indoor orientation and mobility (O&M) skills. Enhancing the mobility skills of the aged VIP may increase the individual's physical abilities and confidence (Ross, 1984).

The choice of self-propelling wheelchairs for spinal patients

This abstract demonstrates that in England, wheelchairs provided by the Government are the core of mobility support to spine-injured patients who have retained self-propelling ability. They provide for all indoor mobility needs during early rehabilitation and, for over half of such patients, indefinitely. Yet 45% of patients stated that they were not satisfied with these wheelchairs, and even 39% of the patients who were satisfied had sought alternative provision. A group of young, active patients exists who need lighter, higher performance chairs which are only available commercially at present. Because of the high cost of these alternative chairs, patients should be advised to wait until they are well adapted in all respects to the consequences of their disability before making a major decision.