Effects of smartphone texting on the visual perception and dynamic walking stability

Traffic safety and public health in China - Past knowledge, current status, and future directions

Transportation-related harms have developed into a social disease, threatening public safety and health in China. We aimed to increase the global understanding of traffic safety and public health in China from past knowledge, current status, and future directions by collecting, collating, and analyzing the Chinese traffic incidents reported in the published literature. A systematic search of China National Knowledge Infrastructure, Weipu, and published articles referenced in PubMed, Web of Science and ProQuest between January 1, 1988 and April 30, 2023 was performed. China encountered the first recorded traffic accident as early as three thousand years ago in the Shang Dynasty. An increase in vehicle capacity and velocity increased the traffic risks during the transition from rickshaws and livestock to motor vehicles in varying traffic environments. Humans are not only the decisive factor of a large number of vehicles, traffic routes, and environmental variables, but also the victims at the end and starting point of traffic accidents. Injuries (mechanical force, burns) and diseases (traffic-related air pollution, noise) caused by traffic activities not only threaten public health, but also cause risks to safe driving. Analysis of traffic activities and biomarkers promotes the treatment of traffic injuries in ethology and medicine. China prepared for the construction of healthy transportation in the "decade of road safety" toward an estimation of worldwide road traffic injuries in 2030. Improvement of traffic safety concerning public health under the "Outline of the National Comprehensive Three-dimensional Transportation Network Planning" in China will propel the realization of worldwide traffic environmental advancement.

Effects of smartphone use while walking on external knee abduction moment peak: A crossover randomized trial on an instrumented treadmill

Introduction

In addition to its effects on cognitive awareness, smartphone use while walking may reduce the speed, regularity, and symmetry of walking. Although its effects on spatiotemporal gait parameters, such as walking speed and step width, have already been studied, little is currently known about the impact of smartphone dual tasking on lower limb kinetics.

Research question

Does smartphone use during walking alter gait patterns (i.e., walking speed and step width) and consequently external knee moments?

Methods

In a four-period crossover trial, external knee moment peaks, walking speed, and step width were assessed in 27 healthy adults during matched-speed walking, self-paced walking, self-paced walking with spoken calculation tasks, and self-paced walking with smartphone-entered calculation tasks. Differences between the smartphone use condition and all other conditions were determined using repeated measures ANOVA with predefined contrasts.

Results

Decreased walking speed and increased step width were observed during smartphone use. The mean external knee abduction moment peak (Nm/kg) differed significantly (p < 0.01) across the intervention condition, namely walking with smartphone-entered calculations (0.15; 95 % CI: 0.12, 0.18), and the control conditions, namely matched-speed walking (0.11; 95 % CI: 0.08, 0.13), self-paced walking (0.11; 95 % CI: 0.09, 0.14), and walking with spoken calculations (0.14; 95 % CI: 0.12, 0.16). After confounder adjustment for walking speed, step width, gender, and age, this primary outcome was significantly different between using the smartphone and self-paced walking (p < 0.01, r = 0.51). This effect size was reduced when comparing smartphone use with spoken calculations (p = 0.04, r = 0.32).

Conclusion

When using a smartphone while walking, walking speed is slowed down, step width is increased, and knee moments are adversely altered compared to walking without dual tasking. These altered knee moments are partially, but not entirely, attributable to the cognitive calculation task. These effects are age-independent, but women are more affected than men. Nevertheless, it remains unclear whether sustained walking while using a smartphone adversely affects the development of knee joint pathologies.

Smartphones and rightward collisions

People tend to deviate to the right when walking through a narrow aperture (e.g., a doorway), resulting in a rightward bias in collisions. This study examines the effects of smartphone use on rightward collisions while walking. When pedestrians walk through a narrow aperture, they usually head straight to the perceived centre of the aperture, which is shifted slightly to the right, without updating the estimates. The rightward shift of the perceived centre is attributable to the rightward attentional shift in the extrapersonal space. Pedestrians using smartphones tend to fixate on the phone most of the time and thus tend not to look at their surroundings (i.e., extrapersonal space). Therefore, we predict that smartphone use will reduce rightward collisions. To test this prediction, we used a narrow-doorway task in which participants walked through a narrow doorway either with or without a smartphone. The participants with smartphones used them to perform either verbal or spatial tasks. The number of rightward collisions decreased when the participants used smartphones. The type of task had no effect on the lateral collision biases. These results were interpreted in terms of lateral attentional bias in peripersonal and extrapersonal spaces.

Dual-tasking interference is exacerbated outdoors: A pilot study

Introduction

Walking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments.

Methods

Twenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments.

Results

While there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008).

Discussion

Dual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.

Does texting while walking affect spatiotemporal gait parameters in healthy adults, older people, and persons with motor or cognitive disorders? A systematic review and meta-analysis

BACKGROUND

Smartphone use during postural-locomotor tasks is an everyday activity for individuals of all ages in diverse environmental situations and with various health conditions. Nevertheless, the use of smartphones during walking is responsible for many accidents.

RESEARCH QUESTION

This systematic review and meta-analysis examined spatiotemporal gait parameters during the dual-task situation "texting + gait" versus isolated gait task (single task) in adult persons (>18 years).

METHODS

Electronic database searches were performed in PubMed, Embase, CINHAL, and LISSA. Two examiners assessed the eligibility and quality of appraisal with the Downs and Black checklist. The standardized mean difference (SMD) with 95 % confidence intervals was calculated to compare single- and dual-task situations. The pooled estimates of the overall effect were computed using a random or fixed effects method, and forest plots were generated.

RESULTS AND SIGNIFICANCE

A total of 25 studies were included. All studies included healthy adults, with four studies including older persons and three including people with pathological conditions. The walking task was with (N = 4) and without (N = 21) obstacles and in laboratory (N = 21) or ecological conditions (N = 7). The quality scores were 6-8/16 for eight studies, 9-12/16 for seven studies, and more than 12/16 for three studies. During the "texting + gait" tasks, the meta-analysis highlighted a significant impairment of gait speed, step and stride length, cadence, and double and single support (p < 0.05). The spatiotemporal parameters of gait were systematically altered during the texting task regardless of the population and test conditions. However, the quality of the studies is moderate, and few studies have been conducted for people with motor deficiencies. The impact of texting on walking should be better considered to develop prevention actions.

Safe stairway negotiation: Role of distractions and handrail use

INTRODUCTION

This study sought to examine stairway safety by identifying associations between fall-related events on stairways, distractions, gait speed, drifting, as well as handrail use and proximity.

METHOD

Video recordings captured 11,137 observations of stair users in two public stairways and recorded distractions (e.g., looking at a mobile device, talking on a mobile device, using earbuds or headphones, holding a mobile device, or talking with a peer), gait speed (m/s), drifting (change of direction), as well as handrail use and proximity to a handrail.

RESULTS

In our sample, consisting of primarily young adults (observed 18-40 years old), we found that when a distraction was present, gait speed was reduced (p &lt;.001), drifting increased (p &lt;.001), and handrail use negatively impacted (p &lt;.001) compared to stair users who were not distracted.

CONCLUSIONS

These results indicate that distractions, such as mobile devices, used during stair negotiation can reduce handrail use and increase behaviors associated with fall-related events.

PRACTICAL APPLICATIONS

Mobile device use during stairway negotiation increases the likelihood of distraction-induced events. Stair users should be encouraged to limit or avoid mobile device use in public stairway environments. Mobile manufacturers and mobile app developers could aim to develop strategies or mobile app alerts to reduce the impact of distractions (e.g., mobile device use) during stair negotiation to lessen the health and financial burden associated with fall-related events on stairways.

Effects of Smartphone Overdependence and the Quality of Friendship on Depression among High School Students

This study analyzes the effects of smartphone overdependence and the quality of friendship on depression among high school students in Korea. The study subjects were 121 high school students. Smartphone overdependence was assessed using the smartphone overdependence scale for adolescents, depression was assessed using the Korean version of the patient health questionnaire-9, and the quality of friendship was assessed using the friendship quality questionnaire. The results of the correlation analysis showed statistically significant differences among all the variables. The results of the multiple linear regression analysis showed that smartphone overdependence increases the depression level, whereas the quality of friendship lowers it. To decrease depression among high school students, smartphone overdependence and the quality of friendship should be managed appropriately. Moreover, the causal relationships and mediating effects between smartphone overdependence and the quality of friendship should be analyzed.

The effects of mobile phone use on motor variability patterns during gait

Mobile phone use affects the dynamics of gait by impairing visual control of the surrounding environment and introducing additional cognitive demands. Although it has been shown that using a mobile phone alters whole-body dynamic stability, no clear information exists on its impacts on motor variability during gait. This study aimed at assessing the impacts of various types of mobile phone use on motor variability during gait; quantified using the short- and long-term Lyapunov Exponent (λ_S and λ_L) of lower limb joint angles and muscle activation patterns, as well as the centre of mass position. Fourteen females and Fifteen males (27.72 ± 4.61 years, body mass: 70.24 ± 14.13 Kg, height: 173.31 ± 10.97 cm) walked on a treadmill under six conditions: normal walking, normal walking in low-light, walking while looking at the phone, walking while looking at the phone in low-light, walking and talking on the phone, and walking and listening to music. Variability of the hip (p λ_S = .015, λ_L = .043) and pelvis (p λ_S = .039, λ_L = .017) joint sagittal angles significantly increased when the participants walked and looked at the phone, either in normal or in low-light conditions. No significant difference was observed in the variability of the centre of mass position and muscle activation patterns. When individuals walk and look at the phone screen, the hip and knee joints are constantly trying to adopt a new angle to regulate and maintain gait stability, which might put an additional strain on the neuromuscular system. To this end, it is recommended not to look at the mobile phone screen while walking, particularly in public places with higher risks of falls.

The effects of walking speed and mobile phone use on the walking dynamics of young adults

Walking while using a mobile phone has been shown to affect the walking dynamics of young adults. However, this has only been investigated using treadmill walking at a fixed walking speed. In this study, the dynamics of over ground walking were investigated using lower trunk acceleration measured over 12 consecutive trials, following differing walking speed and mobile phone use instructions. Higher walking speed significantly increased the proportion of acceleration along the vertical measurement axis, while decreasing the proportion of acceleration along the anteroposterior axis (p < 0.001). Moreover, higher walking speed also resulted in increased sample entropy along all measurement axes (p < 0.05). When walking while texting, the maximum Lyapunov exponent increased along the anteroposterior and vertical measurement axes (p < 0.05), while sample entropy decreased significantly along the vertical axis (p < 0.001). Walking speed and mobile phone use both affect the walking dynamics of young adults. Walking while texting appears to produce a reduction in local dynamic stability and an increase in regularity, however, caution is required when interpreting the extent of this task effect, since walking speed also affected walking dynamics.

Between Post-Flâneur and Smartphone Zombie: Smartphone Users’ Altering Visual Attention and Walking Behavior in Public Space

The extensive use of smartphones in our everyday lives has created new modes of appropriation and behavior in public spaces. Recognition of these are essential for urban design and planning practices which help us to improve the relationship between humans, technologies, and urban environment. This study aims to research smartphone users in public space by observing their altering visual attention and walking behavior, and, in this way, to reveal the emergent “new figures”. For this purpose, Korenmarkt square in Ghent, Belgium, was observed for seven days in 10-min time intervals. The gaze and walking behavior of smartphone users were encoded as geo-located and temporal data, analyzed and mapped using statistical and spatial analysis methods. Developing and implementing new methods for identifying the characteristics of smartphone users, this study resulted in a nuanced characterization of novel spatial appropriations. The findings led to a better understanding and knowledge of the different behavior patterns of emergent figures such as “post-flâneurs” and “smartphone zombies” while uncovering their altering visual interactions with and movements in the public space. The results evoked questions on how researchers and designers can make use of spatial analysis methods and rethink the public space of the future as a hybrid construct integrating the virtual and the physical.

Effects of the use of mobile phone on postural and locomotor tasks: a scoping review

BACKGROUND

Using a mobile phone while performing a postural and locomotor tasks is a common, daily situation. Conversing or sending messages (SMS) while walking account for a significant share of accidental injuries. Therefore, understanding the consequences of using a mobile phone on balance and walking is important, all the more so when these postural and locomotor tasks are aggravated by a disease.

RESEARCH QUESTION

Our objective was to conduct a scoping review on the influence of a dual-task situation - generated by the use of mobile phone - on users' postural and/or locomotor tasks.

METHODS

The literature search was conducted in English on PubMed/Medline and CINHAL databases, using keywords associated with postural and locomotor tasks and with the use of mobile phone. Study location, population, number of subjects, experimental design, types of phone use, evaluated postural-locomotor tasks and expected effects were then analyzed.

RESULTS AND SIGNIFICANCE

46 studies were included in this work, 24 of which came from North America. All studies compared postural and locomotor tasks with and without the use of a smartphone. Ten studies also compared at least 2 groups with different characteristics. Only 4 studies included pathological subjects. Various modalities were tested, and most studies focused on walking. Results show that the use of smartphones slows down movement and induces a systematic imbalance, except when listening to music. The dual task of "using the smartphone during a postural or locomotor tasks" induces systematic disturbances of balance and movement, which must be taken into account in the rehabilitation approach. Future studies will have to extend the knowledge regarding pathological situations.

Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study

PURPOSE

To determine the impact of smartphone use on neck impairment and functional limitation in university students.

METHODS

A cross-sectional correlational study was conducted in a sample of students selected through convenience sampling between September 2016 and March 2017. The inclusion criteria were university students at the School of Medicine and Surgery, routine/daily use of mobile devices with advanced computing and connectivity capability built on an operating system, and aged 18-30 years. Participants completed questionnaires that measured general characteristics of smartphone use and demographic characteristics. Neck pain was assessed using a visual analogue pain score (VAS) and a pain drawing (PD); disability status was measured using the Neck Disability Index (NDI-I); and cervical postures while using the phone were captured using the Deluxe Cervical Range of Motion (CROM) device.

RESULTS

A total of 238 volunteers were recruited (22.4 ± 2.2 years of age, 53.4% males), 35.9% of whom were overweight (>25 BMI). Regarding neck pain, 42.4% reported mild pain, 8.4% had moderate pain, and the remaining 49.2% had no pain. NDI-I and VAS were 3.8 ± 3.8 and 13.6 ± 18.4 mm, respectively. The pain categories did not influence the variables. No significant correlations were observed between the number of hours spent and posture (CROM) while using a smartphone and neck pain and NDI-I.

CONCLUSION

While half of young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability. While we wait for future prospective studies, there is no reason to recommend a change in smartphone use habits among young adults in the meantime.

Factors Influencing the Smartphone Usage Behavior of Pedestrians: Observational Study on "Spanish Smombies"

Background

Smartphone addiction has become a reality accepted by all. Some previous studies have shown that the use of smartphones on public roads while walking is very common among the young population. The term “smombie” or smartphone zombie has been coined for this behavior. Such behavior causes a reduction in the attention given to other pedestrians and drivers and may result in accidents or collisions. However, there are no precise data about how many people use the phone while they are walking on the street. Smartphone usage habits are evolving rapidly, and more in-depth information is required, particularly about how users interact with their devices while walking: traditional phone conversations (phone close to the ear), voice chats (phone in front of the head), waiting for notifications (phone in hand), text chats (user touching the screen), etc. This in-depth information may be useful for carrying out specific preventive actions in both the education field (raising awareness about the risks) and in the infrastructure field (redesigning the cities to increase safety).

Objective

This study aimed to gather information about pedestrians’ smartphone usage and to identify population groups wherein interventions should be focused to prevent accidents. The main hypothesis was that gender, age, and city area can significantly influence the smartphone usage of the pedestrians while walking.

Methods

An observational study of pedestrians in the street was carried out in Elche, a medium-sized Spanish city of 230,000 inhabitants. The following data were gathered: gender, age group, location, and type of smartphone interaction. A specific smartphone app was developed to acquire data with high reliability. The statistical significance of each variable was evaluated using chi-squared tests, and Cramér’s V statistic was used to measure the effect sizes. Observer agreement was checked by the Cohen kappa analysis.

Results

The behavior of 3301 pedestrians was analyzed, of which 1770 (53.6%) were females. As expected, the effect of the main variables studied was statistically significant, although with a small effect size: gender (P<.001, V=0.12), age (P<.001, V=0.18), and city area (P<.001, V=0.16). The phone in hand or “holding” behavior was particularly dependent on gender for all age groups (P<.001, V=0.09) and to a greater extent in young people (P<.001, V=0.16). Approximately 39.7% (222/559) of the young women observed showed “holding” or “smombie” behavior, and they comprised the highest proportion among all age and gender groups.

Conclusions

An in-depth analysis of smartphone usage while walking revealed that certain population groups (especially young women) have a high risk of being involved in accidents due to smartphone usage. Interventions aimed at reducing the risk of falls and collisions should be focused in these groups.

The efficacy of physical therapy on the improvement of the motor components of visual attention in children with cerebral palsy: a case series study

This paper has attempted to compare the effects of Bobath's concept with control's session on the improvement of visual attention in children with cerebral palsy. A 10 children sample (7 girls and 3 boys) aged 6 to 16 years (median, 12 years) was collected. The group who had received Bobath-based treatment crossed-over to control treatment and the previous control group received Bobath-based treatment for once a week. Measures were assessed at pre- and posttreatment. Outcome measure included the visual attention, we used Conners' Kiddie Continuous Performance Test (K-CPT). Bobath's session targeted to crossed-over participants produced greater improvements in K-CPT(RT) (difference=33.1, P<0.05) at posttreatment compared to the control's session group, whereas the improvement of K-CPT did not differ between groups. The results of this case series study showed a significant improvement on visual attention through the improvement of motor control functions after the Bobath's session over the control's session.

Effects of a priority-based dual task on gait velocity and variability in older adults with mild cognitive impairment

The purpose of this study to investigate how gait velocity and variability were affected by dual task prioritization in older adults with normal cognitive function and older adults with mild cognitive impairment (MCI). Eight older adults with MCI and eight cognitively normal older adults performed a walking task under usual walking with no dual task (usual gait), walk while counting backward from 100 by ones with no priority on task (no priority), walk and count while instructed to prioritize gait task (gait priority), and walk and count while instructed to prioritize the cognitive task (cognitive priority). The MCI group showed significantly slower walking speed than the normal group in the no priority condition, but no difference between both group in the usual gait condition, and they almost 3 times greater gait variability in the no priority condition than the normal group. For the effect of priority instructions, MCI group showed a dual-task cost to gait velocity almost 2 times higher than that of the normal group in the no priority condition, but the cost was almost three times higher in both gait and cognitive priority conditions. Although there was no interaction effect for gait variability, MCI group tended to be more influenced by dual task prioritization than the normal group. Our findings confirmed that the priority-based dual task paradigm is a valid way to assess gait characteristics of people with cognitive problems.

What affects gait performance during walking while texting? A comparison of motor, visual and cognitive factors

Texting on a cell phone disrupts walkers' gait performance. The performance decrement has been attributed to increased motor demand, decreased visual information and increased cognitive load. However, relative contributions of motor, visual and cognitive factors are poorly understood. Here we quantitatively estimated the relative contributions of these factors by comparing multiple walking conditions. Thirty-two adults walked for 20 m, with or without a dual task on the phone. The dual task was either a cognitively demanding digit ordering task or a casual tapping task. Gait performance was assessed using gait speed, stride length, stride time and stride time variability. Results showed that texting negatively impacted gait performance. Importantly, we found that cognitive factor contributed the most, visual factor the least, and motor factor in between. Our findings resolve the inconsistency in the literature and unambiguously show that motor, visual and cognitive factors caused by simultaneous phone use all contribute to gait alterations. Practitioner Summary: Walking performance is typically worsened when a concurrent phone use task such as texting is performed. We found that visual, motor and cognitive factors contributed to this performance decrement with increasing importance. Besides resolving inconsistency among previous reports, we also raised theoretical and practical concerns for phone use during walking.

Texting While Walking Induces Gait Pattern Alterations in Healthy Older Adults

The use of a mobile phone for texting purposes results in distracted walking which may lead to injuries. In particular, texting while walking has been shown to induce significant alterations in gait patterns. This study aimed to assess whether changes in the main spatio-temporal parameters of gait when simultaneously engaged in texting on a smartphone and walking are different in older adults relative to young and middle- aged individuals. A total of 57 participants divided in three groups (19 older adults aged over 65, 19 young aged 20-40 and 19 middle-aged aged 41-64) were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back. The results show that texting induced similar reduction of gait speed, stride length and cadence in all groups. Slight (although significant) alterations of stance, swing and double support phases duration were found only for middle-aged participants. Such findings suggest that modifications of gait patterns due to texting seem unaffected by age, probably due to different perceptions of the cognitive complexity of the task and differential prioritization of its motor and cognitive aspects.

Texting while walking differently alters gait patterns in people with multiple sclerosis and healthy individuals

BACKGROUND

In recent times, increasing safety concerns have been associated with the use of mobile phones by pedestrians. In particular, texting has been shown to significantly alter gait patterns. However, no specific investigations have been performed on people with Multiple Sclerosis (pwMS), who are already characterized by gait dysfunctions caused by the disease.

OBJECTIVE

To assess the existence of possible alterations in spatio-temporal parameters of gait in pwMS when simultaneously texting on a smartphone and walking.

METHODS

Fifty-four pwMS (mean age 40.5 ± 10.5) and 40 age-matched unaffected individuals were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back.

RESULTS

Texting induces reduction of gait speed, stride length and cadence in both groups, but such changes were smaller in magnitude in pwMS. An increase of stance and double support and reduction of swing phase were observed in pwMS only.

CONCLUSIONS

Texting alters gait patterns of pwMS differently from unaffected individuals, probably due to a different prioritization of the task, which appears to take into account the motor and sensory impairments associated with the disease by favoring the motor task.