Safe Walking Research Articles

Challenges and opportunity in mobility among older adults – key determinant identification

BackgroundAttention is focused on the health and physical fitness of older adults due to their increasing age. Maintaining physical abilities, including safe walking and movement, significantly contributes to the perception of health in old age. One of the early signs of declining fitness in older adults is limited mobility. Approximately one third of 70-year-olds and most 80-year-olds report restrictions on mobility in their apartments and immediate surroundings. Restriction or loss of mobility is a complex multifactorial process, which makes older adults prone to falls, injuries, and hospitalizations and worsens their quality of life while increasing overall mortality.ObjectiveThe objective of the study is to identify the factors that have had a significant impact on mobility in recent years and currently, and to identify gaps in our understanding of these factors. The study aims to highlight areas where further research is needed and where new and effective solutions are required.MethodsThe PRISMA methodology was used to conduct a scoping review in the Scopus and Web of Science databases. Papers published from 2007 to 2021 were searched in November 2021. Of these, 52 papers were selected from the initial 788 outputs for the final analysis.ResultsThe final selected papers were analyzed, and the key determinants were found to be environmental, physical, cognitive, and psychosocial, which confirms the findings of previous studies. One new determinant is technological. New and effective solutions lie in understanding the interactions between different determinants of mobility, addressing environmental factors, and exploring opportunities in the context of emerging technologies, such as the integration of smart home technologies, design of accessible and age-friendly public spaces, development of policies and regulations, and exploration of innovative financing models to support the integration of assistive technologies into the lives of seniors.ConclusionFor an effective and comprehensive solution to support senior mobility, the determinants cannot be solved separately. Physical, cognitive, psychosocial, and technological determinants can often be perceived as the cause/motivation for mobility. Further research on these determinants can help to arrive at solutions for environmental determinants, which, in turn, will help improve mobility. Future studies should investigate financial aspects, especially since many technological solutions are expensive and not commonly available, which limits their use.

A registered report of a crossover study on the effects of face masks on walking adaptability in people with Parkinson's disease and multiple sclerosis.

Face masks protrude into the lower visual field causing reduced perception of visual stimuli, potentially making obstacle avoidance during walking more difficult and increasing fall risk. Recommendations on walking and mask wearing for older adults have been debated, with no clear consensus on the various factors interacting and influencing walking safety while wearing a face mask. It is particularly important to address this issue in populations at an increased risk of falls. Therefore, this study aims to investigate the effects of mask-wearing on objectively measured walking adaptability in people with Parkinson's disease and Multiple Sclerosis. 50 patients with either Parkinson's disease or Multiple Sclerosis attending inpatient neurorehabilitation will be recruited to participate in this crossover study. Performance during a standardized gait adaptability (C-Gait) test on a VR-based treadmill (C-Mill+VR), as well as during clinical mobility tests (10-meter walk test, Timed Up & Go test, and stair ambulation) will be measured with and without an FFP2- mask (order randomized). In addition, participants will be asked about their perceived performance and perceived safety during the tests with and without a mask. Performance on the seven C-Gait subtests is based on centre of pressure-derived measures of foot placement in relation to the different tasks. These are averaged and added to a cognitive C-Gait task to give the overall composite score (primary outcome). Secondary outcomes will include the different subscores and clinical mobility tests. This study will make an important contribution to an ongoing debate regarding recommendations persons with and without a neurological disease should be given regarding wearing a face mask while walking. Furthermore, the study will complement the existing scientific discourse with clinical data from people with a neurological disease for whom falls, mobility deficits and mask wearing may be more frequent, which can help inform evidence-based recommendations. German clinical trial register: DRKS00030207.

Pedestrian Crossing Sensing Based on Hough Space Analysis to Support Visually Impaired Pedestrians.

There are many visually impaired people globally, and it is important to support their ability to walk independently. Acoustic signals and escort zones have been installed on pedestrian crossings for the visually impaired people to walk safely; however, pedestrian accidents, including those involving the visually impaired, continue to occur. Therefore, to realize safe walking for the visually impaired on pedestrian crossings, we present an automatic sensing method for pedestrian crossings using images from cameras attached to them. Because the white rectangular stripes that mark pedestrian crossings are aligned, we focused on the edges of these rectangular stripes and proposed a novel pedestrian crossing sensing method based on the dispersion of the slope of a straight line in Hough space. Our proposed method possesses unique characteristics that allow it to effectively handle challenging scenarios that traditional methods struggle with. It excels at detecting crosswalks even in low-light conditions during nighttime when illumination levels may vary. Moreover, it can detect crosswalks even when certain areas are partially obscured by objects or obstructions. By minimizing computational costs, our method achieves high real-time performance, ensuring efficient and timely crosswalk detection in real-world environments. Specifically, our proposed method demonstrates an impressive accuracy rate of 98.47%. Additionally, the algorithm can be executed at almost real-time speeds (approximately 10.5 fps) using a Jetson Nano small-type computer, showcasing its suitability as a wearable device.

Discovery and verification of traction weakening effect between multi track shoe of deep-sea miner and sediment

The commercial exploitation of the deep-sea massive deep-sea polymetallic nodules depends on the excellent tractive performance of the deep-sea tracked miner. The walking safety and trafficability of the deep-sea tracked miner are greatly influenced by the traction of the crawler with multi track shoes. The total tractions generated from the two cases of failure surface under the uniformed pressure are deduced and analyzed based on the principle of virtual power. By substituting specified parameters, the traction weakening effect of multi track shoes is discovered, and then corresponding expression is put forward and verified by comparing the tested and theoretical traction relationships based on the traction test of multi track shoes. The research results show that the height and the distance should be considered into the design in a comprehensive way because of the existence of the weakening effect. The mechanism revealing of the source of the multi track shoe tractions could help to achieve the appropriate size of the track shoe and more traction according to the different track shoe distance.

Gait Stability Characteristics in Able-Bodied Individuals During Self-paced Inclined Treadmill Walking: Within-Subject Repeated-Measures Study.

Inclined walking is a challenging task that requires active neuromuscular control to maintain stability. However, the adaptive strategies that preserve stability during inclined walking are not well understood. Investigating the effects of self-paced inclined treadmill walking on gait stability characteristics and the activation patterns of key lower limb muscles can provide insights into these strategies. The aim of this study was to investigate the effects of self-paced inclined treadmill walking on gait stability characteristics and the activation of key lower limb muscles. Twenty-eight able-bodied individuals (mean age 25.02, SD 2.06 years) walked on an augmented instrumented treadmill for 3 minutes at 3 inclination angles (-8°, 0°, and 8°) at their preferred walking speed. Changes in gait characteristics (ie, stability, walking speed, spatial-temporal, kinematic, and muscle forces) across inclination angles were assessed using a repeated measures ANOVA and the Friedman test. The study revealed that inclined treadmill walking has a significant impact on gait characteristics (P<.001). Changes were observed in spatial-temporal parameters, joint angles, and muscle activations depending on the treadmill inclination. Specifically, stability and walking speed decreased significantly during uphill walking, indicating that it was the most challenging walking condition. Uphill walking also led to a decrease in spatial parameters by at least 13.53% and a 5.26% to 10.96% increase in temporal parameters. Furthermore, joint kinematics and peak activation of several muscles, including the hamstrings (biceps femoris, long head=109.5%, biceps femoris, short head=53.3%, semimembranosus=98.9%, semitendinosus=90.9%), gastrocnemius (medial gastrocnemius=40.6%, lateral gastrocnemius=35.3%), and vastii muscles (vastus intermedius=12.8%, vastus lateralis=16.7%) increased significantly during uphill walking. In contrast, downhill walking resulted in bilateral reductions in spatial-temporal gait parameters, with knee flexion increasing and hip flexion and ankle dorsiflexion decreasing. The peak activation of antagonist muscles, such as the quadriceps, tibialis anterior, and tibialis posterior, significantly increased during downhill walking (rectus femoris=97.7%, vastus lateralis =70.6%, vastus intermedius=68.7%, tibialis anterior=72%, tibialis posterior=107.1%). Our findings demonstrate that able-bodied individuals adopt specific walking patterns during inclined treadmill walking to maintain a comfortable and safe walking performance. The results suggest that inclined treadmill walking has the potential to serve as a functional assessment and rehabilitation tool for gait stability by targeting muscle training. Future research should investigate the effects of inclined treadmill walking on individuals with gait impairments and the potential benefits of targeted muscle training. A better understanding of the adaptive strategies used during inclined walking may lead to the development of more effective rehabilitation interventions for individuals with lower limb injuries.

P69: ECMO mobilizing device

Extracorporeal Membrane Oxygenation (ECMO) is a temporary lifesaving treatment for critically ill patients suffering from severe respiratory and/or cardiac failure. Studies have demonstrated the feasibility of mobilization in ECMO patients within the hospital during their bridge to recovery or transplantation. Ambulatory ECMO is a comprehensive form of mobilization aimed at preventing neuromuscular weakness and impaired physical functioning during and after treatment. Despite more compact and mobile ECMO devices, the implementation of ambulatory ECMO remains a labour-intensive, complex, and challenging operation. Ambulatory ECMO requires a large multidisciplinary team to carry all the equipment, to monitor and physically support the patient, and to provide a back-up wheelchair in case of patient fatigue. Additionally, current device configuration contributes to unnecessary device transport. Moreover, there is no adequate solution for ensuring the stability of the patient’s cannula and circuit management during ambulation. We developed a system that contributes to the improvement and innovation of current ambulatory ECMO patient programs and combines: (1) A modular cart-in-cart system (A) consisting of two distinct carts - the stationary cart (B) and the ambulatory cart (C). The stationary cart carries the devices (e.g. heater-cooler) not required during ambulation and remains in the ICU next to the patient’s bed. The ambulatory cart carries all the necessary devices during ambulation and features an extendable walking frame (D) that ensures safe walking support for the patient. A foldable seat (E) allows the patient to sit and facilitates transport back to the ICU in case of patient fatigue. Additionally, a safety brake system prevents unintentional movement of the ambulatory cart. Devices on both carts can be (dis)connected through a multi-connector hub, enabling easy configuration of necessary fluids, gases, and electricity. The connection between the stationary and ambulatory cart is maintained by a foot pedal-controlled lift mechanism that prevents accidental disconnection of the multi-connector and enables transport of both carts simultaneously. The system also features a gas switching device that allows for convenient switching between wall-mounted gas and bottled gas. (2) A universal-sized shoulder brace (F) with integrated blood tubing connector that can be adjusted to the patient via Velcro closure, facilitates secure fixation of the blood tubing, and minimizes strain on the cannula. At the time of writing, the project is undergoing design optimization. Subsequently, a physical prototype will be constructed and subjected to verification and validation processes. Internal testing will be performed to assess compliance with the user requirements. The prototype will then be evaluated in a simulated ICU environment to determine its suitability for use in a clinical setting. The patent for this invention has been filed and is currently pending.

IOT Based Smart Blind Stick

Abstract: People who are blind today must deal with several challenges in their daily lives. Using a blind stick to direct them and a buzzer to inform them with beeps is the new strategy that is presented in this system to assist them. Any object, including impediments, might be easily located with the use of an ultrasonic sensor. They could message a relative in case of any issues. In order to assist people who are blind or visually impaired, the "IoT based blind stick" project is proposed. This proposed system is implemented using Renesas. An IoT project is useful for the blind person and sensors are also connecting to a blind stick. They can use this stick for safe walk and they could move from one place to another place.

Dual-task walking on real-world surfaces: Adaptive changes in walking speed, step width and step height in young and older adults

ObjectivesAge-related changes in dual-task walking are well established, but research in this topic is based on evidence from laboratory rather than real-world studies. We investigated how dual-task walking on real-world surfaces affects young and older adults' gait characteristics and cognitive resource allocation. MethodSixteen young (aged 19–35, 12 female) and fifteen older adults (aged 70–85, 7 female) with no major neurological or musculoskeletal disorders walked at a self-selected speed on forty-metre outdoor paths that had asphalt or grass surface. They walked with or without a cognitive task (counting backwards). Cognitive task difficulty was individually adjusted at 80 % accuracy. Participants performed the three tasks in Single Task (ST Asphalt, ST Grass, ST Cognitive) and Dual Task context (DT Asphalt-Cognitive, DT Grass-Cognitive). ResultsThe two groups showed similar dual task effects in cognition and walking speed, both of which were slower when dual-task walking. Older adults' steps were wider overall but only young adults widened their step width when dual-task walking on grass compared to asphalt. Similarly, young adults' step height increased from single to dual-task walking when on grass, where older adults' did not. DiscussionThe lack of adaptation of step width and height when dual-task walking may leave older adults vulnerable to tripping or falling in common real-world conditions, such as while walking on grass, gravel, or uneven city sidewalks. Considering this, the built environment should be made more accessible to facilitate older adults' safe walking.

Blood flow restricted walking in patients suffering from intermittent claudication: a case series feasibility and safety study.

Sixteen patients with IC were recruited from two departments of vascular surgery. The BFR-W programme implied the application of a pneumatic cuff around the proximal part of the affected limb at 60% limb occlusion pressure in five intervals of 2min, four times per week for 12 weeks. Feasibility was evaluated by adherence and completion rates of the BFR-W programme. Safety was evaluated by adverse events, ankle-brachial index (ABI) at baseline and follow-up, and pain on a numerical rating scale (NRS pain) before and 2min after training sessions. Furthermore, changes in performance between baseline and follow-up were evaluated with the 30 seconds sit-to-stand test (30STS), the 6-minute walk test (6MWT) and the IC questionnaire (ICQ). Fifteen out of 16 patients completed the 12-week BFR-W programme and adherence was 92.8% (95% CI: 83.4; 100%). One adverse event unrelated to the intervention was reported causing one patient to terminate the programme 2 weeks prematurely. Mean NRS pain 2min following BFR-W was 1.8 (95% CI [1.7-2]). ABI, 30STS, 6MWT and ICQ score were improved at follow-up. BFR-W is feasible and appears to be safe in terms of completion rate, adherence to the training protocol, and adverse events in patients with IC. Further investigation of the effectiveness and safety of BFR-W compared to regular walking exercise is needed.

Overview of Walking Rates, Walking Safety, and Government Policies to Encourage More and Safer Walking in Europe and North America

Walking is the most sustainable means of daily travel for short trip distances and is a key component of the overall transport system. This paper documents variation in walking rates among countries, cities in the same country, and in different parts of the same city. Our international analysis of official government statistics shows that walking rates are highest for short trips, higher for women than for men, decline with increasing income, and remain constant as age increases. Walking fatality rates are much higher in the USA compared with the other countries we examined, both per capita and per km walked. Government policies that would increase walking rates while improving pedestrian safety include: integrated networks of safe and convenient walking infrastructure; roadways and intersections designed for the needs of pedestrians; land-use regulations that encourage mixed uses and short trip distances; lower city-wide speed limits and traffic calming in residential neighborhoods; reduced supply and increased price of parking; traffic laws that give priority to pedestrians; improved traffic education for motorists and non-motorists; tax surcharges on large personal vehicles; and strict enforcement of laws against drink and distracted driving. Five decades of success with these policies in many European cities provide practical examples for car-oriented cities to follow, especially in North America.

Identifying Outdoor Winter Walking Programs and Resources for Older Adults: A Scoping Review of the Grey Literature

Purpose: The objective was to synthesize outdoor winter walking programs and resources for older adults, identified as a priority by the Winter Walk team comprised of older adults; and researchers and trainees from the rehabilitation and geography sciences. Method: A scoping review of web-based grey literature was conducted. Teams of two reviewers independently assessed eligibility and extracted data. Web-based resources were included if their content dealt with adults ≥65 years of age; an outdoor winter walking program, intervention, or general resource; and was written in English. Results: Twenty-seven website resources were eligible and included in the review. Resources were from Canada or the United States and included information provided by government, non-profit organizations, media and businesses. All resources focused on some aspect of winter walking safety and only one mentioned a winter walking program. Conclusions: Web-based resources for outdoor winter walking were synthesized to assist older adults and clinicians with access to safe outdoor winter walking information.

Unpacking the concept of 20-minute neighbourhoods: disentangling “desired outcomes” from the “means” available for achieving them

PurposeAn in-depth literature review was undertaken to uncover (1) what are described as the desired outcomes for 20 minute neighbourhoods (20MNs) – the normatively based ends which planners, architects and decision-makers want 20MNs to achieve; (2) the means (the mechanisms, levers, triggers and causal factors) that have to be correctly assembled and lined up for 20MNs to operate as intended and (3), in order to avoid naive environmental determinism, the behavioural changes required to support the operation of 20MNs even where the required configuration of means can be achieved. The content analysis was conducted following guidelines offered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria.Design/methodology/approachGrowing interest in the urban design concept of the “20MNs” has been greatly accelerated by the COVID-19 pandemic. It has been presented as a way of increasing the quality of local environments by enabling people to meet their daily needs through access to safe walking and cycling routes or by public transport. Internationally, it has captured the imagination of political decision-makers, built-environment practitioners and communities alike, as a life-affirming post-pandemic vision, held up as achieving environmental, health and economic improvements as well as reducing inequalities experienced by many. This paper's overall purpose is to separate the ends pursued in 20MNs from means available for achieving them.FindingsThe paper concludes that the ambition to see the 20MNs widely woven into existing urban, suburban and rural neighbourhoods will require significant effort to ensure all that all the component parts of, and key players in, planning's place-delivery systems are aligned and mutually supportive. Even where this can be achieved, further guidance will be needed on (1) how to operationalise the practical implementation of 20MNs and (2) how their success can be measured.Originality/valueThe originality of the paper lies in its efforts to discriminate between ends and means – between desired outcomes of 20MNs and the means available for achieving them. The significance of the paper lies here in this attempt to initiate a discussion on possible causal relationships between what is wanted and what would need to be done to achieve it. Without clarity about these relationships, misunderstanding, confusion and barriers to communication may arise across the many different organizations, stakeholder groups and actors involved. This lack of clarity could undermine trust and confidence, potentially undermining both the process and to its outcomes.

Influence of neighborhood-level social determinants of health on a heart-healthy lifestyle among Black church members: A mixed-methods study

BackgroundFew church-based health interventions have evaluated the influence of neighborhood-level social determinants of health (SDOH) on adopting heart-healthy lifestyles; none has occurred in Louisiana. We aimed to characterize neighborhood-level SDOH that may influence the ability to adopt a heart-healthy lifestyle among Black community church members in New Orleans, LA. MethodsThis mixed methods study used quantitative data (surveys) and qualitative data (focus groups) to explore SDOH at the neighborhood- and church-area- level, including factors related to the physical (e.g., walkability, accessibility to recreational facilities) and social (e.g., social cohesion, perceived safety) environments. Descriptive analyses were conducted for quantitative data. Qualitative data were coded and analyzed using grounded theory and thematic analysis. ResultsAmong survey respondents (n = 302, 77 % female, 99 % Black), most reported having walkable neighborhood sidewalks and high neighborhood social cohesion. Two-thirds did not feel violence was a problem in their neighborhood and felt safe walking, day, or night. Focus group participants (n = 27, 74 % female, 100 % Black) reported facilitators to heart-healthy living, including social support promoting physical activity, intentionality in growing, buying, and preparing produce, and the neighborhood-built environment. Reported barriers included: crime, the COVID-19 pandemic, individual-level factors limiting physical activity, and city-wide disparities influencing health. Participants discussed strategies to promote healthy living, centered around the theme of establishing and rebuilding community relationships. ConclusionsFuture health interventions aimed at improving cardiovascular outcomes among church communities should continue to inquire about neighborhood-level SDOH and tailor interventions, as appropriate, to address barriers and leverage facilitators within these communities.

Informing Streetscape Design with Citizen Perceptions of Safety and Place: An Immersive Virtual Environment E-Participation Method.

As our cities grow, it is important to develop policies and streetscape designs that provide pedestrians with safe comfortable walking conditions and acknowledge the challenges involved in making urban places feel liveable and safe while understanding the critical role of streets around busy destinations. To understand these challenges at a nuanced, human level, new methods of citizen engagement are needed. This paper outlines the development and application of a new citizen perception collection method, using immersive virtual environments (IVE), coupled with an interactive emoji affective activation-pleasure grid and digital slider elements, embedded within an online e-participation survey to quantify, and rank the impact of individual (single-variable) urban design elements and safe system treatments on pedestrians' perceptions of safety and place. The results demonstrate the effectiveness of this method for providing detailed, interrogable, scalable citizen perception data of a variety of urban street design elements and safe system treatments, which allows a statistical analysis of responses and prioritization of the most effective pedestrian-oriented interventions for maintaining or enhancing street vibrancy and liveability. Our IVE e-participation approach is an important contribution to forming a better understanding of streetscapes and provides a valuable method for urban designers and transport planners to prioritise different streetscape place and safety approaches.

ANALYZING PEDESTRIANS' PERCEPTION OF SECURITY IN URBAN STREETS: THE EFFECTS OF ENVIRONMENT ON EEG PATTERN

The walkability is a significant indicator of livability of urban areas, which is determined by various factors of street conditions. The security of streets has direct impact on pedestrians’ walking experience and relates to incidence of actual crimes or aggressive behaviors against pedestrians. In order to improve the security level of urban streets and build a comfortable and safe walking environment for citizens, on one hand, it should be figured out what the influential factors of occurrence of security issues are, and on the other hand, it’s also essential to clarify that how pedestrians’ perception of security is influenced. People’s perception is identified to be influenced by external urban environment, therefore the environmental features of urban streets were involved in analysis. This research aims to clarify the effects of built environment and street configuration on pedestrians’ perception of security, by using the technology of electroencephalogram (EEG) to measure the level of psycho-physiological reaction of pedestrians in real-time walking. The correlations between participants’ emotional feelings and environmental features was analyzed, and the gendered and temporal differences of participants’ emotional responses were clarified.

COGNITIVE FUNCTION CONTRIBUTES TO THE NONLINEAR RELATIONSHIP BETWEEN AGE AND DUAL-TASK GAIT IN MID-AGED POPULATION

Abstract The capacity to maintain safe walking is critical to functional independence in older adults. However, the timing/stage when such capacity starts to diminish, and its potential contributors have not been well characterized. To explore that, we here conducted analysis based upon the data of 651 participants of age between 40 and 65 years from Barcelona Brain Health Initiative Study. Each participants completed: 1) one 45-second trial of walking normally (single-task) and while performing a serial-subtraction-by-three task (dual-task), of which gait was measured using a smartphone-based gait-assessment application; and 2) a battery of cognitive tests. The dual-task cost (DTC) (i.e., percent changes from single- to dual-task condition) to mean stride time (ST) and stride time variability (STV) and the score of global cognitive function were obtained. The LOESS analyses demonstrated nonlinear relationships between age and DTCs with a turning point at age of 54 years (R2&amp;gt;3%). Regression models showed significantly greater associations (p=0.01~0.03) between age and DTCs (i.e., older age, worse gait) (β=0.22~0.28, p&amp;lt; 0.006), as well as between global cognitive function and DTCs (β=-0.28~-0.18, p&amp;lt; 0.002), in older group (i.e., age≥54 years) compared to younger group. The structural-equation-modeling suggested that in older group, cognitive function mediated the relationship between age and dual-task gait (p&amp;lt; 0.02) with a contribution of 43~47% to such relationship. The observations here revealed that as early at age of 54 years, dual-task gait starts to significantly diminish, and its dependence on cognitive function dramatically increases, providing critical knowledge for the management of mobility and cognitive aging in mid-age population.

Hierarchical clustering for crime rate mapping in Indonesia

The Sustainable Development Goals (SDGs) are a blueprint for improving the human life quality. Goal 16 (G16) is related to security, and it is in line with the Universal Declaration of Human Rights and the Preamble to the 1945 Constitution. To support the implementation of the G16 achievement, the Indonesian National Police (Polri) has made serious efforts to provide a sense of safety for the community and to minimize crime rates. One of the efforts that could be made is to map areas based on the level of crimes so that the Polri can determine the appropriate strategy/priority of action for mitigation. Therefore, this study aimed to cluster provinces in Indonesia based on the four G16 indicators of the SDGs related to security, namely the number of homicide cases, the victim proportion, the proportion of people who feel safe walking alone in the area where they live, and the proportion of victims of violence that reported to the police in the past year using five hierarchical clustering methods, namely: Single-Linkage, Average-Linkage, Complete-Linkage, Ward, and Division Analysis. Then, methods were validated and compared using six cluster validations to obtain the most compact method. The results showed that Ward's method outperformed the others and produced three clusters. Clusters 1, 2, and 3 contained 18, 5, and 11 provinces respectively.

One-year impact of a multicomponent, street-level design intervention in Mexico City on pedestrian crashes: a quasi-experimental study

BackgroundMexico City implemented the Pasos Seguros programme to prevent pedestrian injuries and deaths at dangerous road intersections, which included street-level design changes, such as visible pedestrian crossings, sidewalk widening, refuge...

Six Minutes Walking in Polio Survivors: Effects on Fatigue and Walking Adaptability

To investigate whether 6-min walking is fatiguing for polio survivors, and how fatigue influences their normal and adaptive walking. Cross-sectional study. Polio survivors (n = 23) with ≥ 1 fall and/or fear of falling reported in the previous year and healthy individuals (n = 11). Participants performed 1 normal-walk test and 2 walking-adaptability tests (target stepping and narrow-beam walking) on an instrumented treadmill at fixed self-selected speed, each test lasting 6 min. Leg-muscle fatigue (leg-muscle activation, measured with surface electromyography), cardiorespiratory fatigue (heart rate, rate of perceived exertion), gait and walking-adaptability performance were assessed. The study compared: (i) the first and last minute per test, (ii) normal and adaptive walking, and (iii) groups. Leg-muscle activation did not change during normal walking (p > 0.546), but declined over time during adaptive walking, especially in polio survivors (p < 0.030). Cardiorespiratory fatigue increased during all tests (p < 0.001), especially in polio survivors (p < 0.01), and was higher during adaptive than normal walking (p < 0.007). Target-stepping performance declined in both groups (p = 0.007), while narrow-beam walking improved in healthy individuals (p < 0.001) and declined in polio survivors (p < 0.001). Cardiorespiratory fatigue might further degrade walking adaptability, especially among polio survivors during narrow-beam walking. This might increase the risk of falls among polio survivors.

Novel Robotics-Treadmill-Platform Application To Improve Walking In A Person With Parkinson's Disease: A Case Report

<h3>Research Objectives</h3> Illustrate the potential benefits of a 6-week novel Robotic treadmill system training protocol, focused on implicit learning of challenging tasks, on walking performance in an older adult with Parkinson's Disease. <h3>Design</h3> A single-subject case report. <h3>Setting</h3> Outpatient rehabilitation clinic in the southwestern U.S. <h3>Participants</h3> An 82-year-old-female with a 3-year history of Parkinson's disease (PD) on carbidopa/levodopa (Hoehn and Yahr stage 1) was referred to physical therapy (PT) to improve performance and safety of walking. <h3>Interventions</h3> Twelve twice-weekly PT sessions on the walking robotics platform (KineAssist). The platform allows "self-driven"/intentional movement on the treadmill with body weight support, catching after loss of balance, and including full freedom of movement. The protocol emphasized progressive Endurance, Strength, Speed, and Perturbation exercises individualized to her abilities. <h3>Main Outcome Measures</h3> . The primary outcomes were the overground 6-Min-Walk Test (6MWT), TUG, TUG Carry, TUG Cognitive, and Mini-Best test. Secondary outcomes included 10-Meter-Walk-Test (10MWT) self-selected and max walking speeds assessed via the Robotic treadmill system. <h3>Results</h3> The 6MWT improved 51% (318-481m); the TUG score improved 53% (10.3-5.5 sec); the TUG Carry, 50% faster (13.7- 6.8 sec); the TUG Cognitive, 50% faster (13.2- 6.5 sec), the Mini-Best Test improved 8 points (18/28-26/28). The self-selected 10MWT speed improved 196% (0.27- 0.8 m/s) and max gait speed by 120% (1.0-2.2 m/s). <h3>Conclusions</h3> An individualized robotic treadmill gait training protocol was used successfully with an older patient with PD, with marked improvement in her walking, exceeding available minimal clinically important distances for all outcome measures. An implicit learning approach, combined with a robotic treadmill, may enable individuals to perform challenging tasks without fear of physical harm and to develop strategies for safe mobility in their environment. <h3>Author(s) Disclosures</h3> The authors declare that they have no relevant or material financial interests related to the research described in this abstract. Dr. Brown is a Co-inventor of a device described in the presentation, but he currently DOES NOT receive any royalties.