15:30 - 17:00
HeiAge Project: Interdisciplinary Research on Maintaining and Improving Mobility in Advanced Age through Technology
Moderation: A. Schlomann, Heidelberg; L. H. Sloot, Heidelberg; H.-W. Wahl, Heidelberg
The potential of digital assistive technologies is discussed to effectively support maintaining and regaining mobility with advanced age, particularly in the context of increased autonomy and well-being. The 5-year-Carl-Zeiss Foundation funded HeiAge project directed by K. Mombaur, A. Schubert, and H.-W. Wahl aims to develop and evaluate smart technologies for various groups of older adults with a strong emphasis on the support of mobility. Subprojects focus on the biomechanical evaluation of balance and motion deterioration with, the development of technologies, training and applications, and support adaptation by systematically testing varying implementation strategies.
Anna Schlomann (sociology) will summarize the overarching structure and aims of HeiAge with an emphasis on the cooperation between the subprojects. This includes the description of a core data set and mixed-method studies to assess older adults’ attitudes towards the HeiAge technologies.
Matthew Millard (mathematics) will provide insight into the differences between younger and older adults in both static and dynamic aspects of balance. During standing up, often resulting in falls in nursing home residents, older adults stay closer to static stability than younger participants. Surprisingly, no systematic difference is observed for dynamic balance.
Lizeth Sloot (biomechanics) applies the balance analysis to evaluate how rollators can stabilize movement in these young and older adults. Comparing two rollators with different handle height, she will show that the effectiveness of assistive devices depends on both the user’s age and handle height.
Christian Werner’s (sport science) talk will focus on the development of an intelligent exergame-based balance platform for motor-cognitive training in older adults. The aim is to develop an exergame which automatically adapts the type and difficulty level of the game task in real-time to the player’s current performance to enable a highly individualized and deficit-oriented training approach.
Thomas Gerhardy (sport science) will present results of an experimental study to explore the effects of age simulation suits. He will show that wearing an age simulation suit results in a significant reduction in physical performance in the geriatric assessments which indicates that age simulation suits can reliably simulate aging processes to some extent. The results will be integrated into a biomechanical evaluation of how these suits affect movement.
The project HeiAge “Assistive Systems and Digital Technologies for Improving Mobility of Older Adults” is an interdisciplinary project directed by Katja Mombaur, Alexander Schubert, and Hans-Werner Wahl at Heidelberg University. Funding comes from the Carl Zeiss Foundation. Within the project new assistive technologies for older adults to maintain and improve mobility at different levels of mobility-impairments are developed and evaluated. The work program of the project is divided into three parts: (1) Fundamentals: basic knowledge on the psychological and biomechanical bases of mobility in high age that serve as basis for technology development; (2) Application: specific technologies are developed and/or evaluated (e.g., sit-to-stand assistance, exoskeleton, exosuit, exergame, aging suit) that address mobility-related aspects in old age; (3) Cross-cutting projects: foster the interdisciplinary cooperation within the HeiAge consortium on legal aspects, ethical questions, and implementation research.
The involvement of potential end-users of the technologies into the research is realized by a user-centered design (UCD) approach in which users directly and decisively influence the development of technologies through their preferences. The cross-cutting project on implementation research combines quantitative and qualitative research methods in a mixed-methods approach. Within this subproject, a common core data set relevant for all subprojects is built up with n = 216 participants who provided substantial longitudinal data on background variables such as health, well-being, and views on aging. Parts of this group have already participated in HeiAge research activities (e.g., online survey, experimental study on aging simulation, online assessment of HeiAge technologies) and will take part in further studies. This all accords with HeiAge’s ambition in terms of serving older adults’ maintenance or regaining of mobility, connected with increased autonomy, self-efficacy, social participation, and well-being.
Sit-to-stand (STS) transitions are a source of injury for older adults: more falls occur during STS than during walking. It is commonly assumed that older adults struggle with STS, in part, due to impaired balance, yet few studies have quantified STS balance. We present a novel analysis of static and dynamic balance and use it to compare the STS balance of 8 older adults to 10 young participants. We report median metric values and use a Wilcoxon rank sum test to compare the groups at seat-off.
Static balance is analyzed using the distance between the center-of-mass-ground-projection (COMgp) and the edge of the base-of-support (BOS); the distance between the COMgp and center-of-pressure (COP); and the COM speed. At seat-off our analysis shows that the older adults stay closer to static stability: they place their COMgp further in the BOS (7.1 vs. 1.3cm, p=0.001), have smaller COMgp-COP excursions (3.1 vs 7.1cm, p=0.009), and are slower (32 vs 40cm/s, p=0.055) than younger subjects.
Dynamic balance is assessed using a model-based method, the foot-placement-estimator (FPE), to calculate a stabilizing COP location. The main quantity of interest, the dynamic-balance margin (DBM), is the distance between the FPE and the nearest BOS edge. Surprisingly both the older adults and the young have a similar DBM (9.8 vs. 10 cm, p=0.829) at seat-off. The more conservative movements of the older adults suggests that they might be compensating in an effort to maintain the DBM as the young.
Many older adults suffer injuries due to falls as their ability to safely move from sit-to-stance (STS) degrades, usually due to leg weakness or impaired balance. Assistive devices are often used for support; however, few studies quantified their effect. We compared balance at seat-off between unassisted and rollator-assisted STS in 8 older (79±8 yr) and 9 younger (28±5 yr) participants. To evaluate support strategies, one rollator had handles at standing (conventional) height (Hhigh) and one at seat-height (Hlow).
Improved static balance was defined as having more distance between the center-of-mass (COM) and the base-of-support (BOS) edge formed by the feet; less distance between COM and center-of-pressure (COP); and lower COM speed. A better dynamic balance margin (DBM) was defined as the COP stabilizing location (modelled using the foot placement estimator approach) being well within the BOS, meaning less need to take a compensatory step.
The support of a conventional rollator depends on age: young participants took longer (30%, p<0.01) and were closer to being statically stable (COMgp-BOS: 4%; COMgp-COP: -38%; COMvel: -32%; all p<0.002), while elderly took less time (28%, p=0.03) and were further from being statically stable (-26%; 38%; -6% respectively; all p<0.05), both with unchanged DBM (<3%). With lower handles, both groups took longer to stand up (both >36%, p<0.015), but young participants got further from being statically stable (COMgp-BOS: -128%; COMgp-COP: 119%; both p<0.002) and worsened their DBM (-33%, p=0.002) compared to higher handles.
These results demonstrate the ineffectiveness of current devices to improve balance during STS in older adults.
Exergames combining physical exercise with cognitively-challenging video game tasks may have fundamental advantages over traditional exercises, providing the opportunity to train motor and cognitive functions in a playful way, track player’s performance for real-time feedback, and adjust training stimuli across a wide range of different game tasks and difficulty levels. For individualization and progression of training, current exergames often still require manual action by the trainer or player to select the type and difficulty of the exergame task. In contrast, this project aims to modify an exergame-based balance platform and develop more intelligent exergames that automatically identify the performance and relevant deficits of the player during gameplay and adapt the motor-cognitive task and its difficulty level (i.e., platform instability, type and difficulty level of the game task) accordingly in real time. As a first step of this development, we modified the balance platform, which can now be actively controlled and adjusted in its instability, and developed various exergame tasks that address different cognitive functions (e.g., processing speed, inhibition, cognitive flexibility). In a second step (currently in preparation), we will investigate the performance of clinically relevant subgroups of older adults (e.g. faller/non-fallers, frail/non-frail, with/with cognitive impairment) in playing these exergame tasks. Participants’ performance and motions on the platform will be evaluated using exergame outcomes (e.g., game scores, reaction/movement times) derived from the platform-integrated sensor technique and 3D motion capturing. The collected data will be analyzed for subgroup-specific differences to identify and define clinically relevant deficits. Findings will then be used for the development, validation and implementation of a real-time assessment strategy into a new exergame software that is able to recognize relevant deficits of a player and adjust the game task and its difficulty level during gameplay accordingly. Providing a highly individualized and deficit-oriented motor-cognitive training approach, such intelligent exergame software might be highly effective in improving mobility performance and reducing fall risk in older adults. The status quo of the project will be presented at the congress.
Background: So-called age simulation suits are currently used in mainly nursing education to provide an aging experience. While there is predominantly evidence supporting a positive effect on empathy toward older persons, studies validating the effect on function such as walking abilities are rare. These could be used to simulate typical aging processes and to incorporate the findings into product development of new technologies for older adults at an early stage.
Methods: In a within-subjects design, 35 healthy middle-aged participants (60.9 ± 6.4 years) were tested in a series of established geriatric assessments with and without an age simulation suit (GERT). Grip strength (indicator for general physical condition), functional mobility performance (Short Physical Performance Battery; Timed Up and Go), leg strength (30sec-Chair-Standing-Test), dynamic balance (short Community Balance and Mobility Scale), and attentional performance in motion (Timed Up and Go dual-task) were assessed.
Results: Wearing an age simulation suit resulted in a significant reduction in physical performance across most assessments. When comparing the performance while wearing the suit to normative values of representative studies, participants‘ grip strength scores fell in the age range of 70-79 years (female) and 80+ (male), while 30Sec-Chair-Standing-Test scores corresponded with 80-84 years (female/ male).
Summary: These results indicate that age simulation suits have the potential to simulate typical aging processes across different functional aspects. Further studies focus on detailed biomechanical assessment of changes in daily movements, such as walking are needed to create a holistic picture of the ability of an age simulation suit.
Diskutantin: C. Müller, Siegen