What Do Older Canadians Think They Need to Walk Well?

Purpose: To identify older Canadians' perception of the importance of expert-generated elements of walking quality, and the contributors to and consequences of perceived walking quality. Method: Cross-sectional survey of 649 adults was conducted through a commercial participant panel, Hosted in Canada Surveys. Results: Of the 649 respondents, 75% were between 65 and 74 years old (25% ≥ 75) and 49% were women. The most important elements were foot, ankle, hip, and knee mobility with little difference in ranks across walking perception (Fr χ12 = 5.0, p > 0.05). People who were older by a decade were more likely to report poorer walking (POR: 1.4; 95% CI: 1.0, 1.7), as were women compared to men, and people who used a walking aid compared to none. Lung disease showed the highest association with a perception of not walking well (POR: 7.2; 95% CI: 3.7, 14.2). The odds of being willing to pay more for a technology to improve walking were always greater for those with a lower perception of their walking quality. Conclusions: People who perceived their walking quality as poor were more likely to report poorer health and were willing to pay more for a technology to improve walking. This supports the opportunity of leveraging wearable technologies to improve walking.

Objectif : déterminer la perception des Canadiens âgés à l'égard de l'importance des éléments relatifs à la qualité de la marche produits par des experts et établir les incitatifs à la perception de la qualité de la marche, de même que les conséquences s'y rapportant. Méthodologie : sondage transversal auprès de 649 adultes au moyen de Hosted in Canada Surveys, un groupe commercial de participants. Résultats : sur les 649 répondants, 75 % étaient âgés de 65 à 74 ans (25 % ≥ 75 ans), et 49 % étaient des femmes. La mobilité du pied, de la cheville, de la hanche et du genou constituait les éléments les plus importants, et le niveau hiérarchique de chacun différait peu en matière de perceptions de la marche (test de Friedman [Fr] χ2 = 5,0, degré de liberté [ddl] 12, p > 0,05). Les personnes âgées d'une décennie de plus risquaient davantage de déclarer moins bien marcher (rapport de cotes proportionnel [RCP] : 1,4; IC à 95 % : 1,0 à 1,7), tout comme les femmes et les personnes qui utilisaient une aide à la marche. La maladie pulmonaire était la plus liée à la perception de moins bien marcher (RCP : 7,2; IC à 95 % : 3,7, 14,2). La probabilité d'être prêt à payer plus cher pour disposer d'une technologie destinée à améliorer la marche était toujours plus forte chez les personnes qui avaient une moins bonne perception de leur qualité de marche. Conclusion : les personnes qui avaient une moins bonne perception de leur qualité de marche étaient plus susceptibles de se déclarer en moins bonne santé et étaient prêtes à payer plus cher pour disposer d'une technologie destinée à améliorer la marche. Cette constatation confirme la possibilité de mettre à profit des technologies portables pour améliorer la marche.

Evidence for the Efficacy of Commercially Available Wearable Biofeedback Gait Devices: Consumer-Centered Review.

BACKGROUND: The number of wearable technological devices or sensors that are commercially available for gait training is increasing. These devices can fill a gap by extending therapy outside the clinical setting. This was shown to be important during the COVID-19 pandemic when people could not access one-on-one treatment. These devices vary widely in terms of mechanisms of therapeutic effect, as well as targeted gait parameters, availability, and strength of the evidence supporting the claims. OBJECTIVE: This study aimed to create an inventory of devices targeting improvement in gait pattern and walking behavior and identify the strength of the evidence underlying the claims of effectiveness for devices that are commercially available to the public. METHODS: As there is no systematic or reproducible way to identify gait training technologies available to the public, we used a pragmatic, iterative approach using both the gray and published literature. Four approaches were used: simple words, including some suggested by laypersons; devices endorsed by condition-specific organizations or charities; impairment-specific search terms; and systematic reviews. A findable list of technological devices targeting walking was extracted separately by 3 authors. For each device identified, the evidence for efficacy was extracted from material displayed on the websites, and full-text articles were obtained from the scientific databases PubMed, Ovid MEDLINE, Scopus, or Google Scholar. Additional information on the target population, mechanism of feedback, evidence for efficacy or effectiveness, and commercial availability was obtained from the published material or websites. A level of evidence was assigned to each study involving the device using the Oxford Centre for Evidence-Based Medicine classification. We also proposed reporting guidelines for the clinical appraisal of devices targeting movement and mobility. RESULTS: The search strategy for this consumer-centered review yielded 17 biofeedback devices that claim to target gait quality improvement through various sensory feedback mechanisms. Of these 17 devices, 11 (65%) are commercially available, and 6 (35%) are at various stages of research and development. Of the 11 commercially available devices, 4 (36%) had findable evidence for efficacy potential supporting the claims. Most of these devices were targeted to people living with Parkinson disease. The reporting of key information about the devices was inconsistent; in addition, there was no summary of research findings in layperson's language. CONCLUSIONS: The amount of information that is currently available to the general public to help them make an informed choice is insufficient, and, at times, the information presented is misleading. The evidence supporting the effectiveness does not cover all aspects of technology uptake. Commercially available technologies help to provide continuity of therapy outside the clinical setting, but there is a need to demonstrate effectiveness to support claims made by the technologies.

A new approach toward gait training in patients with Parkinson's Disease.

BACKGROUND: Typically, people with Parkinson's Disease (PD) progress to develop a gait pattern that is characterized by quick, short and shuffling steps. Gait cycle is altered and lacks definition and fluidity. Gait training combined with a variety of feedback modalities for PD are usually based on non-immediate and externally-based cues but none of these provide real-time feedback on gait quality and acquired gains tend to abate shortly after rehabilitation. Based on principals of motor learning, our team has developed the Heel2Toe sensor to provide real-time auditory feedback during gait training. RESEARCH QUESTION: Is a short-term training using the Heel2Toe sensor feasible and efficient to improve gait in people with PD? Our objectives are to identify the extent of the immediate response to the feedback within the same session and the carry-over response to training and; 2) to identify patients' perceived effects, pleasures and challenges of using the Heel2Toe. METHODS: Single-arm, proof-of-concept study. Six people received five sessions of gait training over a 2-3-week period using the Heel2Toe augmented with mobility exercises as an adjunct to gait training. The main outcomes were technically assessed gait parameters collected over a 2-minute walk test, without and with feedback. Heel2Toe signals were analyzed to extract angular velocity(AV), percentage of good steps, average cadence, and AV coefficient of variation(CV). RESULTS: An immediate response to the Heel2Toe use and a carry-over response to the short-term training with the sensor were observed: an increase in AV with a reduction in CV (better heel strike and gait regularity); an increase in %good steps; and a near-optimal and homogeneous cadence (∼100 steps/min), which is equivalent to a moderate-intensity walking. SIGNIFICANCE: Gait training using the Heel2Toe sensor is feasible and potentially effective for improving gait quality in people with PD. A definitive trial is a logical next step.

Real-Time Auditory Feedback-Induced Adaptation to Walking Among Seniors Using the Heel2Toe Sensor: Proof-of-Concept Study.

BACKGROUND: Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first. OBJECTIVE: This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor. METHODS: A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience. RESULTS: All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping. CONCLUSIONS: Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated.