Combining ambulatory and laboratory assessment of rollator use for balance and mobility in neurologic rehabilitation in-patients

Abstract

Purpose: Despite the common use of rollators (four-wheeled walkers), understanding their effects on gait and balance is limited to laboratory testing rather than everyday use. This study evaluated the utility of an ambulatory assessment approach to examine balance and mobility in everyday conditions compared to a laboratory assessment. Methods: Standing and walking with a rollator was assessed in three neurological rehabilitation in-patients under two conditions: (1) in laboratory (i.e. forceplate, GaitRite), and (2) while performing a natural walking course within and outside of the institution. An instrumented rollator (iWalker) was used to measure variables related to the balance control (e.g. upper limb kinetics), destabilizing events (e.g. stumbling), and environmental context. Results: Two of three patients demonstrated greater reliance on the rollator for standing balance (2.3–5.9 times higher vertical loading, 72–206% increase in COP excursion) and 29–42% faster gait during the walking course compared to the laboratory. Importantly, destabilizing events (collisions, stumbling) were recorded during the walking course. Such events were not observed in the laboratory. Conclusion: This study illustrated a greater reliance on the rollator during challenges in everyday use compared to laboratory assessment and provided evidence of specific circumstances associated with destabilizing events that may precipitate falls in non-laboratory settings.

Implications for Rehabilitation

• The value of combining laboratory and ambulatory assessment approaches to provide a more comprehensive profile of the risks and benefits of rollator use to prevent falling was studied.

• Patients demonstrated greater reliance on rollator assistive devices for standing balance and exhibited higher gait speeds during ambulatory assessment, compared to standard laboratory protocols.

• Repeated instances of events that may precipitate falls (e.g. collisions, stumbling, and unloading behaviors) were observed only during the ambulatory assessment.

• Individual challenges to balance can be used to identify specific training targets, assess suitability for assistive devices, and recommend rehabilitation goals.

• Ambulation aids
• falling
• gait stability
• quiet standing
• stroke
• traumatic brain injury
• wheeled walker

Declaration of interest

None of the authors have a conflict of interest related to the publication of this manuscript. The authors report no declarations of interest.

We acknowledge the support of the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and the Toronto Rehabilitation Institute which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long Term Care in Ontario. We acknowledge the support from the National Institute on Disability and Rehabilitation Research (NIDRR) through the Rehabilitation Engineering Research Center on Universal Design and the Built Environment (grant #H133E050004-08A), a partnership with the Centre for Inclusive Design and Environmental Access (IDEA).

Authors' contributions

The authors conceived the study, participated in its design and coordination, and helped draft the manuscript. J.Y.T. and J.N.C. recruited the participants and collected the data. All authors read and approved the final manuscript.