Quality of Daily-Life Gait: Novel Outcome for Trials that Focus on Balance, Mobility, and Falls

Technological advances in inertial sensors allow for monitoring of daily-life gait characteristics as a proxy for fall risk. The quality of daily-life gait could serve as a valuable outcome for intervention trials, but the uptake of these measures relies on their power to detect relevant changes in fall risk. We collected daily-life gait characteristics in 163 older people (aged 77.5 ± 7.5, 107♀) over two measurement weeks that were two weeks apart. We present variance estimates of daily-life gait characteristics that are sensitive to fall risk and estimate the number of participants required to obtain sufficient statistical power for repeated comparisons. The provided data allows for power analyses for studies using daily-life gait quality as outcome. Our results show that the number of participants required (i.e., 8 to 343 depending on the anticipated effect size and between-measurements correlation) is similar to that generally used in fall prevention trials. We propose that the quality of daily-life gait is a promising outcome for intervention studies that focus on improving balance and mobility and reducing falls.

Download Full-text

Laboratory versus daily life gait characteristics in patients with multiple sclerosis, Parkinson’s disease, and matched controls

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00781-4 ◽

2020 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Vrutangkumar V. Shah ◽

James McNames ◽

Martina Mancini ◽

Patricia Carlson-Kuhta ◽

Rebecca I. Spain ◽

...

Keyword(s):

Multiple Sclerosis ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Neurological Disease ◽

Inertial Sensors ◽

Daily Life ◽

Area Under The Curve ◽

Gait Characteristics ◽

Discrete Moment ◽

Healthy Control

Abstract Background and purpose Recent findings suggest that a gait assessment at a discrete moment in a clinic or laboratory setting may not reflect functional, everyday mobility. As a step towards better understanding gait during daily life in neurological populations, we compared gait measures that best discriminated people with multiple sclerosis (MS) and people with Parkinson’s Disease (PD) from their respective, age-matched, healthy control subjects (MS-Ctl, PD-Ctl) in laboratory tests versus a week of daily life monitoring. Methods We recruited 15 people with MS (age mean ± SD: 49 ± 10 years), 16 MS-Ctl (45 ± 11 years), 16 people with idiopathic PD (71 ± 5 years), and 15 PD-Ctl (69 ± 7 years). Subjects wore 3 inertial sensors (one each foot and lower back) in the laboratory followed by 7 days during daily life. Mann–Whitney U test and area under the curve (AUC) compared differences between PD and PD-Ctl, and between MS and MS-Ctl in the laboratory and in daily life. Results Participants wore sensors for 60–68 h in daily life. Measures that best discriminated gait characteristics in people with MS and PD from their respective control groups were different between the laboratory gait test and a week of daily life. Specifically, the toe-off angle best discriminated MS versus MS-Ctl in the laboratory (AUC [95% CI] = 0.80 [0.63–0.96]) whereas gait speed in daily life (AUC = 0.84 [0.69–1.00]). In contrast, the lumbar coronal range of motion best discriminated PD versus PD-Ctl in the laboratory (AUC = 0.78 [0.59–0.96]) whereas foot-strike angle in daily life (AUC = 0.84 [0.70–0.98]). AUCs were larger in daily life compared to the laboratory. Conclusions Larger AUC for daily life gait measures compared to the laboratory gait measures suggest that daily life monitoring may be more sensitive to impairments from neurological disease, but each neurological disease may require different gait outcome measures.

Download Full-text

Tools for the Care of Elderly People Applying Information and Communications Technology to Fall Risk Assessment

Advances in Science and Technology ◽

10.4028/www.scientific.net/ast.96.73 ◽

2014 ◽

Vol 96 ◽

pp. 73-77

Author(s):

Toshiyo Tamura ◽

Takumi Yosimura

Keyword(s):

Angular Velocity ◽

Fall Risk ◽

Inertial Sensors ◽

Information And Communications Technology ◽

Information And Communication ◽

The Subject ◽

Care Of Elderly ◽

Wearable Inertial Sensors ◽

And Robotics

Assistive devices have been used to improve the quality of life in elderly society, and information and communication technology (ICT) and robotics have been applied extensively to this end. Falls are a common problem and fall risk assessments are created. This study involved assessment related to an application of information technology. First, to monitor and record falls during daily activities, wearable inertial sensors were used . The threshold of acceleration was used to detect falls. To prevent injury during falls, we also developed a wearable airbag system using an accelerometer, angular velocity, and airbags. The subjects wore the airbag vest with a motion detection belt. When the subject fell, the combination of acceleration and angular velocity signals detected the fall and inflated the airbag.

Download Full-text

Ambulatory Fall-Risk Assessment: Amount and Quality of Daily-Life Gait Predict Falls in Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glu225 ◽

2015 ◽

Vol 70 (5) ◽

pp. 608-615 ◽

Cited By ~ 115

Author(s):

Kimberley S. van Schooten ◽

Mirjam Pijnappels ◽

Sietse M. Rispens ◽

Petra J. M. Elders ◽

Paul Lips ◽

...

Keyword(s):

Older Adults ◽

Risk Assessment ◽

Fall Risk ◽

Daily Life ◽

Fall Risk Assessment ◽

Falls In Older Adults

Download Full-text

Association between Daily-Life Gait Quality Characteristics and Physiological Fall Risk in Older People

Sensors ◽

10.3390/s20195580 ◽

2020 ◽

Vol 20 (19) ◽

pp. 5580

Author(s):

Sabine Schootemeijer ◽

Roel H.A. Weijer ◽

Marco J.M. Hoozemans ◽

Kimberley S. van Schooten ◽

Kim Delbaere ◽

...

Keyword(s):

Older People ◽

Fall Risk ◽

Walking Speed ◽

Risk Group ◽

Daily Life ◽

Risk Groups ◽

Sample Entropy ◽

Quality Characteristics ◽

Low Risk ◽

Gait Quality

Gait quality characteristics obtained from accelerometry during daily life are predictive of falls in older people but it is unclear how they relate to fall risk. Our aim was to test whether these gait quality characteristics are associated with the severity of fall risk. We collected one week of trunk accelerometry data from 279 older people (aged 65–95 years; 69.5% female). We used linear regression to investigate the association between six daily-life gait quality characteristics and categorized physiological fall risk (QuickScreen). Logarithmic rate of divergence in the vertical (VT) and anteroposterior (AP) direction were significantly associated with the level of fall risk after correction for walking speed (both p < 0.01). Sample entropy in VT and the mediolateral direction and the gait quality composite were not significantly associated with the level of fall risk. We found significant differences between the high fall risk group and the very low- and low-risk groups, the moderate- and very low-risk and the moderate and low-risk groups for logarithmic rate of divergence in VT and AP (all p ≤ 0.01). We conclude that logarithmic rate of divergence in VT and AP are associated with fall risk, making them feasible to assess the physiological fall risk in older people.

Download Full-text

Does the Evaluation of Gait Quality During Daily Life Provide Insight Into Fall Risk? A Novel Approach Using 3-Day Accelerometer Recordings

Neurorehabilitation and Neural Repair ◽

10.1177/1545968313491004 ◽

2013 ◽

Vol 27 (8) ◽

pp. 742-752 ◽

Cited By ~ 142

Author(s):

Aner Weiss ◽

Marina Brozgol ◽

Moran Dorfman ◽

Talia Herman ◽

Shirley Shema ◽

...

Keyword(s):

Fall Risk ◽

Daily Life ◽

Novel Approach ◽

Gait Quality ◽

Insight Into

Download Full-text

Self-Assessment of Mobility of People over 65 Years of Age

Medicina ◽

10.3390/medicina57090980 ◽

2021 ◽

Vol 57 (9) ◽

pp. 980

Author(s):

Pascal Martin ◽

Alexander Martin Keppler ◽

Paolo Alberton ◽

Carl Neuerburg ◽

Michael Drey ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Homes ◽

Fall Risk ◽

Daily Life ◽

Scoring Systems ◽

Self Assessment ◽

External Assessment ◽

Mobility Score ◽

Parker Mobility Score

Background and Objectives: Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under‑ or overestimate themselves in many aspects. Since this can have serious consequences in their treatment and care, the aim of this study was to identify differences in the self and external assessment of mobility of persons over 65 years of age. Materials and Methods: 222 participants over 65 years of age and one external, closely‑related relative or professional caregiver were interviewed by a unique study assistant using a standardized questionnaire. Participants were divided into people living in nursing homes and independent people living at home, where either the caregivers or the relatives provided the external assessment of mobility, respectively. The questionnaire included demographics, cognitive abilities (Mini Mental Status Test); fall risk (Hendrich 2 Fall Risk Model); as well as the Parker Mobility Score, Barthel Index, and EQ-5D-5L to measure mobility, activities of daily life and quality of life. In each case, the participant and the external person were asked for their assessment to the participants’ mobility situation. Statistical significance of the difference between self and external assessment was calculated with a Wilcoxon rank‑sum test and assumed with a p‑value of ≤ 0.05. Results: Self-assessment indicated a significantly higher value, when compared to an external assessment for the Parker Mobility Score for females in nursing homes (p ≤ 0.01), as well as for the Barthel Index for females (p ≤ 0.01) and males (p ≤ 0.01) in nursing homes. The EQ-5D-5L received a significantly higher self-assessment value for females (p ≤ 0.01) and males (p ≤ 0.01) living at home and females (p ≤ 0.01) and males (p ≤ 0.05) in nursing homes. Conclusions: Persons over 65 years of age tend to overestimate their level of mobility, quality of life and activities of daily life. Especially for people living in nursing homes, these scoring systems should be treated with caution due to the differences between the verbal statements. It is important to properly assess the mobility situation of elderly patients to ensure correct medical treatment and prevention of falls.

Download Full-text

The Relationships Between Fall Risk, Depression, Executive Dysfunctions and Daily Life of Older Adults

10.21203/rs.3.rs-55453/v1 ◽

2020 ◽

Author(s):

Batya Engel Yeger ◽

Yael Zilbershlag

Keyword(s):

Quality Of Life ◽

Older Adults ◽

High Risk ◽

Daily Activity ◽

Fall Risk ◽

Daily Life ◽

Daily Activities ◽

Activity Performance ◽

Executive Dysfunctions

Abstract Background: Falling is a major problem in older adults that may significantly reduce health and quality of life (QOL). Body dysfunctions that include depression, cognitive decline and executive dysfunctions may elevate fall risk and impair daily activities and QOL. Yet, most studies evaluate these body dysfunctions using laboratory measures in clinical settings. The present study aimed to: (1) compare these body dysfunctions between high/low risk fallers (2) examine the relationship between these body dysfunctions among the high risk fallers (3) explore the specific contribution of fall risk as a mediator between depression, executive dysfunctions and daily life. Methods: Participants were 123 older adults who live in the community. Depression and cognitive status were measured by the GDS-15 and the MoCA. Fall risk was determined by a questionnaire supported by the Time Up and Go test (TUG). Executive functions (EF) were assessed by the BRIEF-A and the aEFPT medication management assessment. Daily activity performance was measured by the Barthel Index of ADL and the Instrumental ADL Scale. QOL was measured by the World Health Organization Quality of Life Brief Questionnaire. Results: High fall risk was prevalent among 32% of the sample. High risk fallers had significantly lower cognitive level, higher depression, lower EF, lower daily activity performance and lower QOL. Among the high risk group, lower EF as measured in BRIEF-A scales correlated with lower performance of daily activities and lower QOL. SEM model revealed that fall risk mediated between depression, executive dysfunctions and daily life. Conclusions: Depression and executive dysfunctions are more prevalent in older adults with high fall risk and are significantly related to their daily activity performance and to their QOL. Community fall-prevention and rehabilitation programs should screen for fall risk and related body dysfunctions as expressed during daily activity performance and understand their impacts on people’s QOL.

Download Full-text

Possibility of Estimating the Risk of Falling at the Seat-Off Face While Rising Up from a Chair

Annals of Advanced Biomedical Sciences ◽

10.23880/aabsc-16000157 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Hideo Hirai

Keyword(s):

Quality Of Life ◽

Motor Function ◽

Fall Risk ◽

Daily Life ◽

The Elderly ◽

Horizontal Distance ◽

Risk Of Falling ◽

The Stability ◽

The Relationship

It is known that falls in the daily life of the elderly occur frequently during walking and rising up and greatly affect their quality of life. In the previous study we obtained the COG-heel horizontal distance and the COG horizontal velocity when the subjects performed rising up under the “fastest” or “slowest” velocity task. These seat-off parameters which were an indicator of the stability in rising from a chair were defined based on the relationship between them. In this experiment with healthy adults as subjects the seat-off parameters were found to become a different distribution because of the rising up strategies of each subject. Moreover, based on the relationship between the seat-off parameters and motor function, they could become an index expressing current fall risk and predicting future fall risk.

Download Full-text

Associations between kinesiophobia, performance and functionality in patients with freezing of gait and Parkinson

European Journal of Health Research ◽

10.32457/ejhr.v7i1.1395 ◽

2021 ◽

pp. 1-14

Author(s):

Javier Martín Núñez

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Movement Disorder ◽

Lower Limb ◽

Fall Risk ◽

Daily Life ◽

Freezing Of Gait ◽

Motor Disorder ◽

Activities Of Daily Life

Parkinson´s Disease is the second most common neurodegenerative movement disorder worldwide and the first one in Europe, with a prevalence increasing with age. Freezing of gait is a motor disorder which fundamentally causes a block of lower limb, during this espisode patients can not generate a step. Furthermore, freezing of gait is one of the most motor disabling motor disorder in Parkinson´s Disease, being related to the progression of the disease and sometimes with the appearance of complications. Those complications can include increase fall risk, impairment of activities of daily life and reduction of quality of life; due to the related decrease in movement and physical activity in patients with Parkinson´s Disease and freezing of gait. Despite others studies have shown a relationship between kinesiophobia, physical activity and functionality in patients with Parkinson´s Disease, there are no evidences of this link in patients with Parkinson´s Disease and freezing of gait in ``On´´ state.

Download Full-text