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Going mobile: improving balance and walking for better health
As a PhD student, Dr. William Gage convinced a surgeon to inject him with anaesthetic in his own knee to see what would happen to his balance and movement.
Today, as a Toronto Rehab scientist, Dr. Gage is still probing the mysteries of posture, balance and walking. His goal: to improve mobility and health in people with knee and hip osteoarthritis, joint replacement patients and stroke survivors.
“Mobility is such a critical aspect of quality of life,” says Dr. Gage. “For most of us, mobility is characterized by the ability to walk. But how do humans stand upright? How do we walk?”
One area of focus is something called “variability”. When we walk, every stride we take is a little bit different than the stride before or after. Dr. Gage is trying to understand this.
“We want to know how much variability is good,” he says, “and why it seems to change with age and disease. If we can answer these questions, we can design therapies or interventions.”
Dr. Gage is also figuring out how to improve balance control to reduce the risk of falling. Falls are a very common cause of injury among older people. One of Dr. Gage’s students is testing a new approach with Toronto Rehab patients who have had knee replacement surgery. The researchers want to see if enhancing patients’ control of side-to-side motion by asking them to perform challenging walking tasks, such as side stepping around cones, and side stepping over obstacles, can help them stay upright and cut their risk of falls.
Improving the quality of balance and mobility is one thing, but then there’s the question of quantity. Dr. Gage wants to understand how much activity patients get while in hospital – and after they go home.
To do this, he and other researchers including scientist William McIlroy and student Sanjay Prajapati, have developed a novel way to measure patients’ walking activity. It involves matchbox-sized wireless sensors that collect data on everything from steps per minute to walking quality.
Recently, more than 20 patients in Toronto Rehab’s stroke rehabilitation program wore the sensors from morning to evening. The results were revealing: patients were inactive for large portions of the day. When they did walk, it was not for very long and usually in short bursts of about 30 to 50 seconds – not enough time to attain cardiovascular benefits.
“We want to use this kind of data to guide activity outside therapy so that patients can take advantage of all that time during the hospital day when they could be engaged in beneficial walking activity,” says Dr. Gage.
Next, the team will use the same technology to look at patients’ activity levels once they get home. Studies will involve stroke survivors and also people who have returned to the community after rehabilitation for knee and hip replacement surgery.
“We are convinced that optimizing activity levels is key to avoiding all kinds of future health problems and complications,” says Dr. Gage. “The problem is that people can overestimate the level and quality of activity they are engaged in – and therapists don’t always have the full picture.”
He believes the new remote technology will open up exciting new avenues for treatment. “Therapists could keep track of exactly what patients are doing, and design more specific treatments based on actual activity patterns.” |