Postural and Metabolic Benefits of Using a Forearm Support Walker in Older Adults With Impairments

All hands on deck: The multidisciplinary rehabilitation assessment and management of hand function in persons with neuromuscular disorders

Hand function is important in every aspect of our lives. Across a wide range of neuromuscular disorders-inherited ataxias, motor neuron diseases, polyneuropathies, and myopathies-people can experience losses in hand strength, tone, movement, dexterity, joint range, and sensation. Such changes can adversely affect function and independence in daily activities, reducing participation and quality of life. People with neuromuscular disorders (pwNMD) known to involve the hand should be assessed at regular intervals for changes both clinically and using impairment, performance, function, and patient-reported outcome measures as appropriate. A patient-centered approach to management is recommended, with clinicians partnering with the individual, their caregivers and the interprofessional teams to create personalized solutions that can overcome barriers to participation and best meet the goals of individuals affected by neuromuscular disorders. Management strategies should be multifaceted, and may include exercise, orthoses, assistive devices, technological solutions, environmental or task adaptations, medications, and/or surgery. Exercise recommendations and orthoses should be individualized and evolve based on disease progression, impairments, and functional limitations. While medications and surgery have a small role for specific clinical situations, there is a plethora of assistive and technological solutions to assist with basic and instrumental activities of daily living, work/education, and leisure for pwNMD with reduced hand function. In addition, clinicians should advocate for appropriate accommodations for reduced hand function at work/school, and the development of and adherence to legislation supporting accessibility and inclusion.

Biomechanical effects of human-mobility aid interaction: A narrative review

BACKGROUND

The clinical benefits and widespread use of traditional mobility aids (such as canes, walking frames, wheeled walkers, etc.) have been hampered by improper use, fear of falling, and social stigma. Clarifying the biomechanical impacts of using mobility aids on users is fundamental to optimizing rehabilitation programs.

RESEARCH QUESTION

What are the biomechanical consequences of human-aid interaction and what differences in variables exist across patients and devices?

METHODS

English-language articles from 2000 to May 2024 were identified by searching Web of Science, PubMed, and Google Scholar for the keywords "mobility aids," "walking aids," "assistive devices," "cane," "walking stick," "walking frame," "walker," or "rollator." Articles related to Nordic sticks, crutches, or wheelchairs, as well as dissertations and studies reported only in abstract form, were excluded.

RESULTS

The biomechanical consequences of assisted gait are significantly variable due to individual characteristics, device configuration, and environmental conditions. It is essential to assess the user's residual abilities and assistive needs to determine how the aid will be operated. Appropriate mobility aid selection, height adjustment, and weight-bearing support can enhance the user's functional compensation for the affected side, improving gait, reducing lower limb joint loads, and stimulating muscle activation. Conversely, inappropriate prescriptions may lead to increased energy expenditure and cognitive demands, as well as harm to healthy tissues. Additionally, environmental factors should be taken into account to improve the usability of mobility aids in real-life situations.

SIGNIFICANCE

Low adherence to the use of mobility aids has been influenced by mixed factors in different patient populations. These biomechanical findings provide important support for optimizing personalized guidance and improving assistive device design.

Users' adaptations to the proportional speed control of a motorised walker

PURPOSE

Speed control is commonly used to regulate the forces applied by motorised walkers (MW) and there are often situations where the speed targeted deviates from the preferred walking speed of its users, such as when encouraging higher walking speeds and due to safety consideration. This study investigates the effects of different MW's target speeds on the selected walking speeds, force applied, perceived exertion, and gait of MW users during steady-state walking.

MATERIALS AND METHODS

The spatiotemporal gait parameters and perceived exertion of twenty young healthy participants were measured as they walked at a comfortable, self-selected speed using a MW as it was controlled to target forward speeds of 0.6, 0.8, 1.0, 1.2, and 1.4 m s-1 as well as when no assistive force was applied by the MW.

RESULTS

On average, users would walk slower when their "No Assist" walking speed is higher than the MW's speed target and vice versa. Additionally, the force applied to the MW is proportional to the difference in speed, either faster or slower, when compared to "No Assist".

CONCLUSION

The user's exertion and the energy used by the MW are both minimised when target speed is close to the preferred walking speed of the user. Additionally, these findings suggest that the speed target can be used to change the walking speed of users but only to a certain extend and at the cost of higher perceived exertion.Implications for rehabilitationThe larger the difference between the target speed of the MW and the preferred walking speed of the user, the more likely the user is to push or pull on the MW.Users would push or pull on the MW with a force proportional to the difference from their preferred walking speed even when matching the MW's target speed.Users can be encouraged to walk at higher than preferred speeds, even though this would come at the cost of higher perceived exertion.

Evaluating Gait Stability and Muscle Activation in Different Hand Holding Conditions Using the Robotic Walker-mTPAD

While walkers are used as mobility aids for different gait impairments, little is known about the factors that affect the performance of such aids. Therefore, we investigated the impact of arm-holding conditions on gait stability and muscle activation. We used surface electromyography (sEMG) sensors on specific arm and leg muscles while the users took laps with a robotic walker, the mobile Tethered Pelvic Assist Device (mTPAD), on an instrumented mat. Eleven participants without gait disorders walked with and without a 10% body weight (BW) force applied on the pelvis in the following three configurations: (i) while gripping the walker's frame, (ii) while using an armrest with their arms at a 90∘ angle, and (iii) while using an armrest with their arms at a 130∘ angle for 5 min each. Our results showed that when applying a force, the users changed their gait to increase stability. We also discovered differences in muscle activation based on the user's specific arm conditions. Specifically, the 130∘ condition required the least muscle activation, while gripping the walker's frame increased specific muscle activation compared to 90∘ and 130∘. This study is the first to evaluate how arm-holding and external loading conditions alter gait and muscle activations using the mTPAD.

Ankle Exoskeleton Assistance Can Improve Over-Ground Walking Economy in Individuals With Cerebral Palsy

Individuals with neuromuscular impairment from conditions like cerebral palsy face reduced quality of life due to diminishing mobility and independence. Lower-limb exoskeletons have potential to aid mobility, yet few studies have investigated their use during over-ground walking - an exercise that may contribute to our understanding of potential benefit in free-living settings. The goal of this study was to determine the potential for adaptive plantar-flexor assistance from an untethered ankle exoskeleton to improve over-ground walking economy and speed. Six individuals with cerebral palsy completed three consecutive daily over-ground training sessions to acclimate to, and tune, assistance. During a final assessment visit, metabolic cost, walking speed, and soleus electromyography were collected for baseline, unpowered, low, training-tuned, and high assistance conditions. Compared to each participant's baseline condition, we observed a 3.9 ± 1.9% (p = 0.050) increase in walking speed and a 22.0 ± 4.5% (p = 0.002) reduction in soleus activity with training-tuned assistance; metabolic cost of transport was unchanged (p = 0.130). High assistance resulted in an 8.5 ± 4.0% (p = 0.042) reduction in metabolic cost of transport, a 6.3 ± 2.6% (p = 0.029) increase in walking speed, and a 25.0 ± 4.0% (p < 0.001) reduction in soleus activity. Improvement in exoskeleton-assisted walking economy was related to pre-training baseline walking speed ( [Formula: see text], p = 0.001); the slower and more impaired participants improved the most. Energy cost and preferred walking speed remained generally unchanged for the faster and less impaired participants. These findings demonstrate that powered ankle exoskeletons have the potential to improve mobility-related outcomes for some people with cerebral palsy.