I prefer real life walking rehab, go to a bar, sit on that high top stool, have a couple of drinks and walk through a crowded room to the restroom. You need a challenge and this will get you recovered quite fast. Don't do this, I'm not medically trained.
Mobility Rehab visual feedback system for gait rehabilitation in older adults
Journal of NeuroEngineering and Rehabilitation volume 20, Article number: 144 (2023)
Abstract
Background
Gait and balance impairments are among the main causes of falls in older adults. The feasibility and effectiveness of adding sensor-based feedback to physical therapy (PT) in an outpatient PT setting is unknown. We evaluated the feasibility and effectiveness of PT intervention combined with a therapist-assisted visual feedback system, called Mobility Rehab, (PT + MR) in older adults.
Methods
Twenty-eight older adults with and without neurological diseases were assigned either PT + MR (n = 22) or PT alone (n = 6). Both groups performed 8 sessions (individualized) of 45 min long (30 min for gait training and 15 min for endurance, strength, and balance exercises) in an outpatient clinic. Mobility Rehab uses unobtrusive, inertial sensors on both wrists and feet, and at the sternum level with real-time algorithms to provide real-time feedback on five gait metrics (step duration, stride length, elevation at mid-swing, arm swing range-of-motion [ROM], and trunk coronal ROM), which are displayed on a tablet. The primary outcome was the Activities-specific Balance Confidence scale (ABC). The secondary outcome was gait speed measured with wearable inertial sensors during 2 min of walking.
Results
There were no between-group differences at baseline for any variable (P > 0.05). Neither PT + MR nor PT alone showed significant changes on the ABC scores. PT + MR, but not PT alone, showed significant improvements in gait speed and arm swing ROM. The system was evaluated as ‘easy to use’ by the PT.
Conclusions
Our preliminary results show that PT + MR improves gait speed in older adults with and without neurological diseases in an outpatient clinic.
Clinical Trial Registration
www.ClinicalTrials.gov, identifier: NCT03869879.
Introduction
Gait and balance impairments often lead to falls in older adults and people with neurological diseases (e.g., Parkinson’s disease and stroke) [1,2,3,4]. Gait impairments often manifest as slow gait with increased double support time, reduced stride length, shuffling, and decreased arm swing and turning velocity [3, 5,6,7,8,9]. These deficits in upper and lower body gait metrics, that are usually multifactorial in origin [10], require a comprehensive assessment to identify the risk of falling and to target intervention for older adults and people with neurological diseases.
Although physical therapists observe patients’ walking patterns and provide verbal and/or somatosensory feedback to improve their patients’ mobility, these methods are not optimal because clinical gait observation is subjective, depends on the expertise of the physical therapist (PT) and might be inaccurate [11]. A real-time, objective characterization of gait impairments would allow the PTs to provide patient-specific feedback on gait performance to be used during rehabilitation interventions.
Wearable sensor-based systems can be used to help PTs guide feedback in real-time based on objective measures of gait [12]. Feedback-based interventions, using wearable sensors have shown promising results for gait rehabilitation [12] but studies have been limited to treadmill-based systems and lower body-related metrics [12, 13]. We developed Mobility Rehab a novel, PT-assisted visual feedback system, for providing real-time measures of upper and lower body gait metrics [14].
The Mobility Rehab system uses wireless, inertial sensors (Opals, APDM Wearable Technologies, a Clario company) worn on the wrists, feet, and sternum area to improve the accuracy and effectiveness of PT’s feedback to their patients [14]. The Mobility Rehab system provides feedback on 5 gait metrics: step duration, stride length, elevation of feet at mid-swing, arm swing range-of-motion (ROM), and trunk coronal (mediolateral) ROM.
We previously demonstrated that one session of Mobility Rehab during treadmill gait training showed significant and moderate − to − large effect sizes (ES) in upper and lower body gait metrics (e.g.; arm swing ROM and foot-strike angle) during overground walking in people with Parkinson’s disease [14]. In addition, participants perceived moderate-to-excellent effects on their gait after using the system and no adverse events were reported [14]. These previous results are promising since a meta-analysis showed only small ES of standard PT training on lower body gait metrics, such as gait speed and stride length [15], and no effect on double-support time [15]. In addition, another meta-analysis revealed that patient-perceived mobility, assessed with the Activities − specific Balance Confidence Scale (ABC) scale, did not show significant effects after PT training alone [16]. Thus, we hypothesized that standard PT combined with Mobility Rehab (PT + MR) would be more effective than standard PT gait training alone to improve patient-perceived mobility, gait speed as well as upper and lower body gait metrics. This is a pragmatic clinical trial in an independent outpatient PT clinic that provides standard gait training to older adults and people with neurologic diseases and mobility disturbances.
The objective of this study was to compare the effects of PT + MR versus PT gait training alone, on ABC scores (primary outcome), gait speed (secondary outcome), and exploratory upper and lower body gait metrics (step time asymmetry, foot clearance, arm swing, trunk coronal ROM, and foot strike angle) during overground walking in older adults and people with neurologic diseases in an outpatient PT clinic. We also report the feasibility of using Mobility Rehab in an outpatient physical therapy clinic, where time with each patient is limited.
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