The aim of the white paper summarised in this article is a preliminary assessment of what evidence exists for the efficacy of a smart insole to enhance mobility and thus mental health and social isolation, particularly in the elderly.
According to recent studies a smart insole that monitors gait and activity levels while providing personalised exercises, coaching, and access to an online community has the potential to significantly improve the quality of life (QoL) of older individuals.
]]>According to recent studies a smart insole that monitors gait and activity levels while providing personalised exercises, coaching, and access to an online community has the potential to significantly improve the quality of life (QoL) of older individuals.
Falls are a major issue for the elderly (see Falls in Elderly White Paper). Yearly, 30-40% of people >65 years of age will fall at least once with 32% of these resulting in serious injuries (Ambrose et al. 2015; Sterling et al. 2001). Falls can significantly undermine older adults’ confidence and independence. This can increase social isolation, a major issue in developed nations. For example, in the EU loneliness is common with 30-55% of older people in Central and Eastern Europe and 10-20% in Northwestern Europe feeling lonely (Hansen and Slagsvold 2016). Interestingly, loneliness can, in turn, increase fall risk with a 24% increase in falls noted in people with the least social contact compared with those with the most social contact (Bu et al. 2020).
Our product, IntellAge, are holistic smart insoles that tackle falls and social isolation in the elderly. IntellAge’s discrete sensors allow it to calculate our unique Fall Risk Index (FRI). Its complementary app displays gait, activity level, FRI, and AI-powered personalised exercise instructions based on FRI, age, and health status. Such balance training has been shown to reduce fall risk probability significantly with some reducing fall risk by over 50% (Gardner et al. 2000; Liu-Ambrose 2012). IntellAge’s app is also equipped with a community function to match elderly people with other people in their vicinity with similar interests so they can find exercise/walking/hobby partners as well as coaches to help them build meaningful connections.
Before discussing topics such as social isolation and loneliness, it is important to define these two terms. Although we recognise other definitions exist, this white paper will use the definitions set out in Gardiner et al. Loneliness, refers to the subjective feeling of being alone or more separate from others than desired. Social isolation is “the objective absence or paucity of contacts and interactions between a person and a social network” (Gardiner et al. 2018).
The world population aged >60 years is expected to reach 22% by 2050 (World Population Ageing 2007). Social isolation among the elderly is thus more relevant now than ever. Levels of social isolation/loneliness vary from country to country. A recent meta-analysis showed that the pooled prevalence of loneliness in those >65 is 28.5% with actual values varying from 11 to 55%(Chawla et al. 2021). Importantly, social isolation and loneliness can pose significant threats to the physical and mental wellbeing of older individuals (See - What are the Impacts of Social Isolation & Loneliness?).
Ageing alone does not cause social isolation however studies show that individuals who lack family contact are more likely to be socially isolated and to have higher rates of loneliness. Furthermore, those over 50 are more likely to have experiences that increase their risk of loneliness and social isolation (e.g. death of a loved one, worsening health and chronic illness, new sensory impairment, retirement, changes in income, etc.).
At-risk groups include immigrants and members of the LGBTQ+ community. A recent Canadian study has shown that both recent and long-term immigrants experience significantly greater levels of loneliness than their Canadian-born counterparts (Stick et al. 2021). This increased susceptibility to loneliness is present at almost all educational levels, age groups, income levels, and marital statuses (Stick et al. 2021).
Meanwhile, individuals identifying as LGBTQ+ report higher levels of social isolation than heterosexuals, with social isolation being associated with increased substance use and psychological distress in these populations (Bränström and Pachankis, 2018). Additionally, pre-existing mental health issues such as anxiety and depression can also increase the risk of isolation and loneliness (Evans et al. 2018).
According to studies, frailty, reduced mobility, and other physical disabilities can be major causes of social isolation.
NHS England describes frailty as “a loss of resilience that means people don't bounce back quickly after a physical or mental illness, an accident or other stressful event” and is quantified by a range of measures relating to physical, psychological, and social health (Xie et al. 2017). The most frequently reported components of frailty are mobility and balance, nutrition, and cognitive function (Xie et al. 2017). Analysis of the English Longitudinal Study of Ageing (ELSA) found that loneliness predicted frailty and social isolation (Gale et al., 2018). Fear of falling, a factor closely linked to frailty, is associated with poorer mental health and social isolation in those over 65 (Kumar et al., 2014; Esbrí-Víctor et al. 2017; Hajek et al. 2017).
Individuals who suffer from long-term illnesses or disabilities are 3.75 times more likely to say they feel lonely often or always (Wellbeing and Loneliness - Community Life Survey 2020/21). Studies such as Steptoe et al. confirm this finding showing that limiting longstanding illnesses such as chronic lung disease, arthritis, impaired mobility, and depressive symptoms are associated with social isolation (Steptoe et al. 2013).
Social isolation can have major impacts on both an individual’s psychological and physical health. Physically, social isolation and loneliness are associated with a range of health conditions/negative behaviours, including coronary heart disease, stroke, self-neglect, and clinical depression (Steptoe et al. 2013; Locher et al. 2005). Additionally, loneliness and social isolation are also associated with mortality (Steptoe et al. 2013).
A wide range of interventions has been carried out to tackle the issues of social isolation and loneliness. These include attempting to increase people’s interaction with their peers or others who are lonely, psychological therapies, health and social care provision, activities with animals, befriending interventions and hobby development (Gardiner et al. 2018).
As evidenced in this white paper, IntellAge has the potential to tackle multiple significant issues for the elderly including social isolation, loneliness, and mobility. Not only can IntellAge improve physical health by encouraging exercise and reducing fall risk via personalised balance exercises, but it can also protect against social isolation and loneliness via in-app coaches and community functions. As immobility, lack of physical activity levels, loneliness, and social isolation are all factors that contribute to premature ageing, health conditions, and mortality in the older population, IntellAge is a highly promising intervention for tackling a variety of issues in the elderly population.
Foot pain will be defined as “an unpleasant sensory and emotional experience following perceived damage to any tissue distal to the tibia or fibula (below your shins); including bones, joints, ligaments, muscles, tendons, nerves, skin, etc” (Hawke & Burns, 2009).
The aim of the white paper summarised in this article is to assess what evidence exists for the efficacy of a vibrating insole such as Floave to reduce foot pain.
Our team has been working on developing Floave which consists of a pair of smart insoles and their adjoining app and is aiming to improve your wellbeing and foot health at your fingertips.
All users need to do is connect the insoles to their phones and discover the variety of sessions Floave has to offer.
Click here to read more about Floave.
Foot pain can be disabling, impair mood, behaviour, self-care ability and overall quality of life (QoL). Using the Manchester Foot Pain and Disability Index, one study found that 82% of those with disabling pain said they experienced a functional limitation (e.g. avoiding walking long distances), 86.4% had issues with pain intensity (e.g. doing everything but with more pain or discomfort), and 30% were concerned with foot appearance (Garrow et al. 2004).
Of individuals with disabling foot pain, the most common parts of the foot affected are the great toe, first metatarsal head, mid-foot/arch area and plantar surface of the heel.
Different parts of the foot are affected by different factors. Plantar fasciitis (pain on the bottom of your foot, around your heel and arch) is caused by repeated mechanical overloading and microtrauma. Risk factors are thought to include shortening of the calf muscles, overweight, long periods of employment in non-sedentary occupations, and foot deformities (Gutteck et al. 2019). Meanwhile, pain in the metatarsals (forefoot), also of mechanical origin, is usually associated with metatarsal misalignment or atrophy of the plantar fat pad (pad of fat at the base of the foot). Other underlying diseases (e.g. rheumatoid arthritis) can also cause pain in the forefoot.
Extrinsic factors often linked to foot pain include inappropriate footwear and occupational activities (Hawke & Burns, 2009). A recent systematic review has found that 63-72% of people wear incorrectly fitting shoes (Buldt & Menz, 2018). 84-91% of individuals wearing too loose or too tight shoes experience foot pain (Buldt & Menz, 2018).
Research has shown a higher risk of foot pain in groups such as older people (81%) and children with Down syndrome (46%) resulting from incorrect shoes fitting (Buldt & Menz, 2018). There is evidence older people’s feet have broader forefoot regions, flatter arches, and more deformities compared to young people (Kouchi et al. 1998; Echeita et al. 2016).
63.2% of people have some kind of problem with their feet, while 17-42% of adults are thought to be affected by foot pain (Hill et al. 2008; Badlissi et al. 2005). However, as most studies focus on sub-populations such as the elderly, the prevalence in the general population is unclear (Hawke & Burns, 2009).
A population-based cross-sectional survey of 3417 individuals aged 18-80 years old found that a similar number of men (20%) and women (24%) report foot pain and that in nearly half of cases this pain was disabling (Garrow et al. 2004). Garrow et al. also found that disabling foot pain increases with age, peaking at 55-64 years of age.
Additionally, people with foot disabilities are more likely to have a diagnosed chronic disease than those without foot disabilities (45.9 vs. 16.0%). Garrow et al. found that they were particularly likely to have osteoarthritis, heart disease, diabetes mellitus and rheumatoid arthritis (Garrow et al. 2004).
Treatments differ according to the foot complaint. For example, for plantar fasciitis, first line interventions are self-management techniques such as activity modifications (For those patients who stand for more than 8 hours per day, reduced activity levels and modified work shifts i.e. less than 8 hours should be advised), stretching, footwear advice, insoles, etc. If first line interventions lasting 6-12 weeks are not successful in reducing pain significantly, the clinician will prescribe an orthotic. If following second-line intervention for 12-24 weeks, no significant improvement is seen, third-line intervention will be night splints to be used for 12-16 weeks. Should this fail to produce an improvement, fourth-line interventions including steroid Injections, acupuncture, or Extracorporeal Shock Wave Therapy (ESWT), can be pursued prior to the final intervention of surgery (only after failure to improve on conservative interventions for at least 12 months) NHS (Sheffield Primary Care Trust: Plantar fasciitis- Clinical Pathway; Gutteck et al. 2019). >90% of chronically recurring plantar fasciitis cases can be treated successfully via surgery (Gutteck et al. 2019). Nonetheless, clinicians generally attempt to avoid such invasive procedures.
Vibratory analgesia describes the ability of vibration to reduce pain. Vibratory analgesia has been reported in both animals and humans (Doi et al. 2018; Lundeberg et al. 1987). Vibrations have been used to reduce pain in many parts of the body including the feet (see next section), neck (Beinert et al. 2018), forearms (Staud et al. 2011), and jaws (Bagherian & Sheikhfathollahi 2016). Although the exact mechanisms of vibratory analgesia are still disputed (Hollins et al. 2014), the classical theory is the Gate Control Theory of pain proposed by Melzack and Wall (Melzack & Wall 1965). This theory, simply put, states that non-painful stimuli like vibrations can essentially compete with painful stimuli and reduce pain.
Vibrations have been shown to dampen many different types of pain including cutaneous pain (superficial/skin pain), myalgia (muscle pain), and phantom limb pain (Lundeberg 1985; Lundeberg 1987; Bergomi et al. 2018). One example of pain reduction via a mechanism other than Gate Control Theory is reduction in muscle soreness after exercise. Multiple studies have shown that applying local vibrations using handheld or wearable devices like MyoVolt™ or
VITER VR-7N, ITO before or after exercise can reduce muscle soreness significantly for up to 72 hours (compared to those who exercised without vibrations) (Lu et al. 2019; Bakhtiary et al. 2006; Cochrane 2017). In this case, as the pain is reduced long after the vibrations were applied, it is likely a different mechanism underlying the pain reduction due to vibration.
Containing a wide range of vibrational patterns, Floave can reduce foot pain caused by a variety of factors. While few studies focus on vibrations for pain reduction in feet, vibrations in general in other parts of the body set a clear precedent for the use of vibration to relieve chronic foot pain. Especially considering the high prevalence of foot pain, in the general population, Floave has great potential to improve the lives of many users.
To access the full White Paper and to read more about how Floave can be used to reduce foot pain, complete the form below.
]]>The White Paper summarised in the article aims to assess the effectiveness of a smart insole in the triage and rehabilitation of knee osteoarthritis (KOA) and knee arthroplasty (KA) patients.
A smart insole has the potential to be a key improvement to KOA patients’ quality of life (QoL) via rehabilitation and surgical prioritisation. The literature strongly advocates that smart insoles that monitor plantar pressure, gait, and activity levels can help healthcare professionals (HCPs) triage and rehabilitate KOA and KA patients.
The Walk With Path team has been working on developing Path Insight, a smart insole that fits into everyday enclosed shoes aiming to collect data and give insights using Artificial Intelligence (AI) into a person's function in a useful format for patient education and to support clinical decision making. The insole collects data, such as plantar pressure, temperature and gait analysis, through sensors within the insole. The insole is characterised as smart, as it is connected to a smartphone app for the user and a digital downstream dashboard for healthcare professionals.
Knee osteoarthritis (KOA) is the progressive loss and damage of cartilage covering the bones in the knee joint, most common in the elderly. KOA symptoms often progress, becoming more severe, frequent, and debilitating, although the rate of this deterioration varies from person to person. Common symptoms include knee pain with a gradual onset that worsens with activity, knee stiffness, swelling, and pain after sitting/resting for extended periods of time. Interestingly, only 15–81% of patients with radiographic findings of KOA are symptomatic.
KOA is the most common type of arthritis diagnosed, and its prevalence will continue to increase as life expectancy and obesity rise. Research shows that in those over 70, up to 40% have KOA, with more women suffering from it than men.
The first-line treatment for all patients with symptomatic KOA is patient education and physical therapy. UK National Institute for Health and Care Excellence (NICE) guidelines recommend education, advice, information access, exercise and weight loss as core treatments for all osteoarthritis patients.
If an individual has symptomatic KOA in at least 2 of the 3 compartments of the knee and fails more conservative treatments, surgical procedures, such as knee arthroplasties (KAs), can be used. KAs, also known as knee replacements, are a method of reconstructing the knee joint by removing the damaged parts and replacing them with prostheses. Total knee arthroplasties (TKAs) are highly cost-effective, costing £5,623 per quality-adjusted life-year (QALY) gained per patient.
According to the United Kingdom NICE guidelines, for a patient to be eligible for a KA, there must be significant, prolonged symptoms with supporting clinical and radiological signs; however, beyond this, there is currently no specific threshold for KA patient prioritisation. Thus, in multiple countries including Canada and the UK, hospitals often use a 'first-come-first-served' rule or adopt their own policies on KA prioritisation.
The lack of effective patient prioritisation represents a major issue in several countries as KA delays correlate to greater pain, difficulty with functional tasks, less improvement post-surgery, and reduced quality of life. Although in 2004 the UK government set the goal to reduce waiting times from ‘18 months to 18 weeks’ and this was largely achieved for some time, this goal has not been reached for 5 years now.
Patients with KOA demonstrate reduced gait parameters arising from joint stiffness or reduced muscle strength in the knees, and plantar pressure changes which contribute to foot pronation and pain. The inability to prioritise patients for KA can be solved by classifying KOA and other pathologies severity based on spatiotemporal gait analysis. The literature proposes for stride length and cadence to be used for the classification of KOA severity, where shorter stride length and lower cadence is associated with higher severity. A progressive decrease in cadence, walking speed, mean stride length, swing phase duration and single support phase, and increased stance phase duration and first double support phase correlates with increased KOA severity.
It seems that individuals with KOA tend to have increased foot pronation. For example, some papers have found that plantar pressures in the midfoot and first metatarsophalangeal joint (MPJ) are higher in women with KOA than those without. Other papers have found that KA patients have much higher plantar pressure in the non-operated foot and the heel region of that foot compared to healthy individuals.
Gait parameters seem to improve following KAs. A recent systematic review concluded that TKAs consistently improve postural stability compared to the pre-surgery state. Gait speed, stride length, knee flexion/extension range, and maximal knee flexion all increase 1 year post-TKA compared to pre-TKA. Suh et al. found that gait speed and gait endurance are positively correlated to cadence and stride length while negatively correlated to timed up-and-go, stair-climbing test ascent, stair-climbing test descent, visual analogue scale, WOMAC pain indices, stiffness and function levels following TKAs. In other words, they found that the faster and more you can walk after KA, the greater your cadence, stride length, and functionality and the lower your pain and stiffness levels. However, some papers such as Heil et al. contradict this, showing no significant changes in postural sway or plantar pressure pre and post KA.
Despite improvements in gait parameters, post-KA compared to pre-KA, TKA patients still have worse balance compared to their healthy counterparts. Gait asymmetries in step length have been noted 15 weeks after surgery possibly due to the habit of using crutches in the early postoperative period.
The goal of postoperative care for TKA patients is to restore the greatest possible mobility and muscle control to the knee. Adequate rehabilitation is important for achieving successful TKA outcomes. The exact rehabilitation programme differs from surgeon to surgeon. In-bed rehabilitation starts on day one of surgery. Full weight-bearing is also possible under the supervision of a therapist with a walker. More active rehabilitation exercises, such as straight leg raises, can start one day after surgery. Usually, patients have to show that they can safely walk with an assistive device on flat ground and stairs as well as show the ability to get into bed from sitting or standing positions and good pain control before being discharged from the hospital and going home or to a skilled nursing facility.
After leaving the hospital, patients get a postoperative visit at the two-week mark, where the wound is checked and surgical staples are removed. If not already begun, at this point outpatient physical therapy starts. It usually takes patients 4-6 weeks to improve to the point where they can resume driving and operate car gas pedals safely and rapidly. After 4-10 weeks they can get back to work, depending on what their job is. Patient follow-up is usually at 6 weeks, 3 months, and one year after surgery. Once strength, mobility, and balance are regained, patients can resume low-impact sporting activities although high-impact activities are discouraged.
Although post-surgery rehabilitation improves outcomes and can be more cost-effective than usual care for at least 9 out of 10 patients, >50% of patients fail to continue recommended aftercare following inpatient rehabilitation. NICE recommends the need for further research on long-term follow-up and monitoring after joint replacement surgery.
There are now a few tech solutions targeting KA care. IDEEA(r), GaitSmart, SHIMMER3 IMU, and ActivPAL3(TM) are technologies that involve placing multiple sensors on the thighs, ankles, and feet or even taping sensors onto patients' skin. However, attaching multiple sensors can be complicated, bulky, and unseemly, making patients less likely to use them and limiting use to in-clinic.
While some of these solutions, such as GaitSmart, do provide personalised rehabilitation exercises for KA patients, they are too complicated for continuous monitoring and thus only function for in-clinic use. Providing only in-clinic monitoring makes such devices less likely to help physicians prioritise patients or motivate exercising devices that continuously patients and provides regular notification updates on their gait improvements such as actively(r) (gait analyzing belt) and mymobility (Apple Watch app). These, however, have lesser accuracy overall, and do not directly measure aspects such as pronation, an element directly linked to KOA pain, such as pronation. Currently, no pressure-sensing insoles for gait analysis pre- or post-KA are available on the market.
As research shows, there is a need for innovation and smart insoles such as Path Insight have a variety of potential applications in the KOA population. Not only can its ability to prioritise patients for KAs help decision making for healthcare professionals and tackle the massive KA backlog, via the use of both pain questionnaires and objective gait metrics, but it can also help reduce inequalities and biases in KA prioritisation. Furthermore, Path Insight’s app will be able to provide patients with standardised clinician-approved information on what to expect before, during, and after surgery. Finally, via monitoring patients’ gait metrics, Path Insight will be able to provide personalised physiotherapist-approved prehabilitation and rehabilitation exercises in order to get KOA and KA patients back on their feet.
To access the full White Paper and to read more about Path Insight and its ability to help professionals in the triage and rehabilitation of knee osteoarthritis and knee arthroplasty patients complete the form below.
]]>Diabetic foot ulcers (DFUs) are a severe complication of diabetes mellitus (DM). They often result from lesions in the plantar tissue that can go unnoticed following the damage to the peripheral nervous system and subsequent loss of foot sensation, termed as diabetic peripheral neuropathy (DPN).
According to the International Diabetes Federation (IDF), DM cases drastically rose in the past years, the number of adults affected by this disease reaching at least 463 million in 2019 compared to 108 million in 1980. Moreover, the number of cases is expected to reach 600 million by 2035.
DM currently affects 60 million European adults, half of which have developed DPN. It has been estimated around 50% of DPN patients will develop DFUs[1] in the following years, which can result in amputations 25% of the time with a 5-year mortality rate of 40%[2].
Diabetic foot complications not only affect the patient and their family's quality of life but also have a serious detrimental economic burden, specifically for those in low-income countries where the cost of treating a diabetic foot problem can be equivalent to 5.7 years of their annual income [6]. Current solutions focus on cure rather than prevention, involving frequent visits to the doctor for diabetic foot assessment which can be costly. The NHS in England has reported the total diabetic foot care cost to be around £935 million or £7,800 per patient for a year for a DFU and £16,900 per amputated wound [5].
The use of telemedicine to self-manage and ultimately prevent DFUs can, however, be extremely cost-effective [7] [8], due to the reduction in ulcer recurrences and fewer screening devices [7]. Taking this into account, Path Feel can provide a much-needed framework for effective management and prevention of DFUs [9].
Due to difficulty healing, amputations, and cost, the best solution for a DFU is prevention. Path Feel will revolutionize DFU prevalence through personalized medicine, integrated care, and diagnostics. Path Feel detects elevated plantar pressure and temperature and provides haptic feedback in response. This facilitates behavioral change through visual alerts, ultimately preventing DFUs whilst improving mobility. Real-time pressure and temperature data, and activity levels are analyzed through a smartphone application. This information is then passed on to healthcare professionals (HCPs) for review through a graded alarm system so that at-risk patients can be prioritized. This information is displayed on a sleek and easy-to-navigate online dashboard, called Path Insight. Thus, the proposed system is a self-monitoring tool that provides real-time personalized analysis on plantar pressure and temperature, activity levels, education, and haptic intervention to not only prevent foot ulceration but also reduce the need for frequent visits to the clinic.
Self-management of DM via remote monitoring of plantar temperature has shown to be efficacious in detecting future DFUs, therefore reducing its incidence. However, adherence to prevention practices through high patient compliance are pivotal in producing effective outcomes. Lavery et al. (2007) indicates compliance with temperature checking resulted in a reduction in DFUs, suggesting that incorporation of a regime involving self-monitoring of plantar temperature would empower self-management of condition; 80% of patients in the trial who developed DFUs did not adhere to the protocol[59]. Unfortunately, many DM patients are limited in assessing their foot conditions, especially whilst using dermal thermometers, as they have visual impairment, obesity or limited joint mobility (as reviewed in Lavery et al. 2007)[59]. Therefore, a telemedicine diagnostic tool such as Path Feel would be ideal. The use of a smartphone application alongside Path Feel can bridge the gap between patient behaviours and the healthcare system, and mitigate risk [55].
DFUs are a devastating complication of diabetes, and early detection of ulcer development is vital in reducing further complications. Personalised alerts to both user and clinician will aim to ensure that appropriate action is taken to reduce DFU risk. Intervention is key to minimise DFU damage, and continuous pressure and temperature monitoring can implement this. Path Feel aims to aid DM patients take control of their foot care, and avoid the devastating effect a DFU can have on daily life.
The white paper aims to investigate even further the feasibility of using pressure and temperature measurements of the sole of the foot to predict formation of DFUs and the benefits of using Path Feel.
The Walk With Path team has been working lately on developing Floave, a wellness device aimed at helping its users keep motivated to remain active, and to contribute to battling the mental health epidemic modern society is facing.
]]>
The White Paper summarized in this article will assess the impact and need for a consumer device which applies insole vibrations, with the purpose of managing anxiety levels, daily activities, exercise and relaxation.
Anxiety is the most common mental health disorder worldwide, with 1 in 3 adults reporting periods of significant anxiety and distress during their lifetime [1].
The WHO estimates that anxiety is one of the top 5 most burdensome disorders globally, significantly impacting both individuals and wider society. It is estimated that approximately 300 million people have a variation of an anxiety disorder worldwide - and this figure is almost certainly an underestimate [3]. Anxiety impacts all age groups, and manifests itself differently depending on age group. It is worth noting that anxiety is more prominent in women than in men.
The current Covid-19 outbreak has resulted in a significant mental health decline mainly due to its subsequent quarantine measures which are “spurring fear on a societal level” [5].Young adults and the elderly population appear to have been most negatively affected by lockdown measures.
Generalised Anxiety Disorder(GAD) is the most common anxiety disorder in the elderly population and young adults. Aside from the mental symptoms of excessive worry and sense of dread experienced by patients due to this disorder, the physical symptoms can often have more severe impacts on daily life. Anxiety disorders have devastating effects on the lives of millions of people, and this is without taking into account the 1% of the population who suffer from OCD, and further 264 million suffering from clinical depression[10].
Several studies have provided evidence that both aerobic (High Intensity Interval Training (HIIT), cardiovascular) and non-aerobic (swimming, yoga) exercise have a significant impact on reducing anxiety. Moreover, consistent exercise has been shown to be more effective in the long term in preventing and treating anxiety disorders compared to both cognitive behavioural therapy (CBT) and medication [12]. Several studies have shown that 100% of participants indicated significant improvement in both their physical and mental wellbeing as a result of taking part in regular HIIT [13].
There are increasingly more studies providing evidence as to the effectiveness of breathing exercises on reducing anxiety [17] [18]. Diaphragmatic breathing in particular has been shown to reduce anxiety levels, as well as reducing blood pressure, increasing blood flow, and reducing
the risk of hypertension [19].
Meditation techniques have also been shown to reduce pain in patients with peripheral neuropathy [21]. Clinicians are increasingly placing greater significance on using breathing exercises to improve mental wellbeing. Evidence shows that breathing exercises regulate the autonomic nervous system (ANS), and can improve the function of the parasympathetic nervous system [22]. Floave’s wide range of breathing exercises are thus designed to simply and effectively improve the user’s wellbeing on-the-go.
Massage is a well established method for promoting relaxation. Focused research on foot massage has reported significant reduction in anxiety and low mood after 20 - 25 minutes of foot massage up to 3 times a week[23][24]. Massage can be used to manage chronic health conditions.
The impact of haptic vibrations on stress levels has been shown to be effective in lowering heart rate - this is a common indicator of reduced anxiety [26]. New research has revealed the potential to use pressure stimulation on the feet, hands and chest to stimulate oxytocin (the happy hormone) production, as well as increase in “pleasant, relaxed, and refreshed feelings” [27]. Further studies have shown that massage can be used as a holistic treatment for behavioural symptoms of dementia, with clinical reduction in anxiety and agitation reported [28].
Alongside general wellbeing, foot vibrations can also be used to treat symptoms of chronic diseases. A specific study into the impact of vibrating insoles in diabetic patients found that a mere thirty minute walk with a vibro-medical insole seems to improve pressure sensation and alter peak pressure in diabetic patients with mild-to-moderate peripheral neuropathy [30].
Each of these holistic methods mentioned above form the core basis of Floave as a wellness product. Floave will aid users in improving their motivation to keep active, and contribute to battling the mental health epidemic modern society is facing. Each feature of the product has been carefully designed and selected to give the user a holistic treatment for the daily stresses and challenges modern life gives us.
Complete the form below to download the white paper.
]]>By amplifying the feet’s sense of touch, Path Feel enables users to identify accurately when their feet touch the ground. This reduces the sense of imbalance, as well as incidence of falls.
The White Paper summarized in this article, will detail the definition of the various gait parameters monitored by Path Feel insoles and the Path Insight dashboard. It will also show how each parameter provides insight into the wearer’s balance and fall risk.
Speed, variability, and symmetry, are 3 general parameters providing information about a person’s gait performance during a gait test, allowing its interpretation.
Speed is the sixth vital medical sign - right after body temperature, respiration rate, blood pressure, and pulse rate. It is an important sign for physicians to identify a slow gait, which can mean reduced physical activity and damaged health. It is usually a warning for complex internal health problems that can lead to reduced survival in older age.
The following table gives typical figures related to gait speed:
To be able to assess a person’s Parkinson’s disease progression, and to predict the risk of falls for elderly patients, it is useful to look at the measure of variation between the duration of the gait cycle of each foot. Low variability is interpreted as “rigidity”, while higher variability can be seen as “instability”. To get a clear interpretation of gait variability, it should be measured when the patient walks freely for a duration of more than 20 cycles.
Gait symmetry indicates the degree of gait control. It is the ratio of swing times comparing how long each foot is in the air. Natural gait is marked by almost symmetric movement patterns of the lower extremities.
Swing time ratio is the most significant parameter to study symmetry of gait, as reduced swing time ratios have been associated with reduced balance in stroke and Parkinson’s patients.
Apart from speed, variability, and symmetry, which are important in assessing gait and determining various factors, there are temporal and spatial gait parameters that can help in the development of solutions to make an individual with risk of falls’ life easier.
These are the parameters that use time as a main indicator of gait. They represent the initial contact and final contact of the foot with the ground. The most used temporal gait parameters are:
These are the parameters that use space as a main indicator of gait. Spatial parameters reflect the antero-posterior and medio-lateral movements of the feet during walking.The most used spatial gait parameters are:
In addition to the above parameters, it is important to measure pressure on a person’s feet and how it is distributed over time. Depending on the individual’s activities, pressure loads across the foot can vary. Compared to people with normal gaits, a person with stumbling gaits has different patterns of plantar pressures. This distribution of pressure can indicate foot deformities, thus leading us to identify risk of falls.
Path Feel insoles measure parameters that lead to fall risk in elderly patients. By providing insight on gait, it plays a large role in the prevention and decrease of falls.
Complete the form below to download the General Gait Parameters white paper.
]]>Vice Chancellor & Senior Research Fellow at Northumbria University in the UK, Honorary Clinical Physiotherapist at Northumbria Healthcare NHS trust, Director of the Physiotherapy Innovation Laboratory (PI Lab), and Previous Parkinson's Foundation Postdoctoral Fellow at Oregon Health and Science University in the USA, Samuel Stuart has been published a great number of times, and has carried out multiple projects.
One of his most impactful publications was Gait in Parkinson's disease: A visuo-cognitive challenge, published in 2016. The study looked at visual function during Gait in Parkinson’s disease, as well as the impact of cognition and response to visual cues. His most recent project studied the brain’s activity response to cues for gait impairment in Parkinson’s disease, with the goal of investigating brain activity response to cues when walking in PD. His many awards and grants made him what he is today, an amazing influence in the world of scientific research.
Our team asked Dr. Stuart questions about himself, Parkinson’s Disease, visual cueing and about the impact of technology on the development of Parkinson’s disease treatment.
A: I am a clinical-academic physiotherapist and currently a Senior Research Fellow at Northumbria University, where I direct the Physiotherapy Innovation Laboratory (PI Lab). I completed my NIHR biomedical research unit funded PhD in neuroscience at Newcastle University in 2016, where I examined the roles of vision and cognition in walking and response to visual cues in Parkinson’s. I moved to Oregon Health & Science University (USA) in 2017 for a postdoctoral fellow position, where I obtained a Parkinson’s Foundation postdoctoral fellowship for basic scientists in 2018.
My fellowship was the first study to examine brain activity while walking without and with visual cues in people with Parkinson’s who did and did not experience freezing of gait. I returned home to the North East of England at the end of 2019, where I began my own laboratory at Northumbria University and obtained a Parkinson’s Foundation Clinical Research Award to examine how comprehensive recordings of brain activity respond to various cueing modalities, such as auditory, visual and tactile cues for gait impairment in Parkinson’s.
A: As a physiotherapist, following a research career and doing your own research is challenging due to the limited support, clinical-academic pathways and funding - especially in comparison to our medical or basic science colleagues. However, I always wanted to develop my knowledge and career, as well as my own line of research that could help answer important clinical questions, in a ‘Lab to Life’ translational approach. I was particularly interested in neuroscience as the human brain is one of the most complex structures, and we know so little about it. This inspired me to carry out a PhD in neuroscience, as there are still so many unanswered questions, puzzles and problems.
A: The aim of my research is to improve mobility and reduce the risk of falls in people with Parkinson’s disease. This can be done through understanding the contribution of sensory and cognitive function to gait. The biggest research goal I have is to understand why cueing modalities work to improve gait in Parkinson’s, so we can develop more effective and targeted interventions.
A: Freezing of gait is a particularly problematic symptom of Parkinson’s. It can have a big impact on a person’s ability to carry out their usual activities, which in turn leads to a lack of independence and reduced quality of life. Most importantly, freezing of gait is associated with an increased risk of falls in people with Parkinson’s, which is associated with greater mortality rates. Therefore, intervention for this symptom is paramount.
A: I have studied the use of visual cues for gait impairment in Parkinson’s for 8 years on various projects. There are a range of benefits, that include: improvement in walking (such as longer step length and reduced freezing episodes), greater visual exploration of the environment when walking, and changes in brain activity when walking in regions associated with sensory function.
A: Current assessment and treatment of Parkinson’s is conducted by clinicians. However, this typically involves a ‘snap-shot’ visit and relies heavily on clinical expertise. The advancement of modern technology will allow for development of more comprehensive data-driven objective assessments of Parkinson’s symptoms, as well as individualised or continuous intervention for particular problems, such as mobility impairment. Technology will provide the key to unlocking more effective treatment of Parkinson’s, with the ability for patients and clinicians to work together to ensure personalised healthcare.
]]>PD symptoms increase the risk of falls leading to injury and complications resulting in a lower quality of life, which can snowball into other mental health issues in patients. PD ranks as the number 1 priority for research focusing on healthcare by Parkinson’s UK.
While PD manifests through motor and non-motor symptoms, it is the motor aspects (such as resting tremor, bradykinesia, rigidity, and postural instability) that increase the risk of falls and that cause Freezing of Gait (FOG). FOG is a common symptom for people with PD. It occurs when the patient is unable to start or continue walking, and feels like their feet stick to the ground. Often accompanied by shaking legs, it is quite disturbing for PD patients. FOG normally occurs in episodes when a patient is in the advanced stage of the disease however, it can also happen in the earlier stages. Lasting up to a few minutes, the freezing leads to difficult horizontal walking. But the patient can still walk vertically (for example, climb stairs).
Freezing of gait is usually handled with drugs or cueing. Visual and auditory cues are more effective than pharmacological treatments. How so? In addition to having no side-effects, cues trigger more beneficently the patient’s ability to take a horizontal step. The limitation in drug-efficacy has led clinicians to look for a treatment that uses sensory cueing.
Gait is negatively influenced by attention processing when going through a dual-task (e.g walking and talking simultaneously). As deficits in executive function (including attention) are common, they are combined with reduced basal ganglia activation which results in gait initiation fails in PD patients. Sensory cues provide an external trigger that can start that movement and allows the person to take the step with the guidance of that external cue.
The cue works by activating the motor cortex rather than the impaired basal ganglia. The motor cortex remains intact in PD. Visual cues have shown to have significant improvement in movement amplitude in people with or without FOG.
If PD patients find themselves shuffling, freezing, and having movement blockages, struggling to start walking or can still go up the stairs better than walking on a flat surface, Path Finder is the medical device that will help ease freezing. Path Finder is a laser light cueing device attached to the person’s shoe. It constantly projects a green laser line in front of the opposite foot, for every step, removing the need for the person walking to activate the light during FOG episodes. The cue helps the brain to start movement for the person, encouraging walking again.
Path Finder provides cues only when the opposite foot is in contact with the floor, thus allowing continuous cueing. This decreases the duration of freezing episodes more than on-demand cueing because it brings more attention to the act of gait. Cueing reduces the duration of freezing episodes. The risk of falling is also reduced as it is highest during the first few seconds of the freezing episode.
By decreasing the need to internally plan and prepare movements, external cues remove the cognitive load, allowing the patient to focus his attention on walking, making gait a priority. Visual cues improve movement amplitudes in people with and without FOG, making Path Finder a beneficial assistant to PD patients not only when they experience freezing.
People with Parkinson’s can keep their quality of life by managing symptoms as much as possible. Freezing of Gait is a serious symptom of PD and Path Finder is a safety net that patients can rely on. It gives people the confidence to move on their own.
Path Finder has been making the lives of Parkinson’s patients easier and better since Spring 2017.
Click here for more information about Path Finder.
Vital signs are indicators of functional health. Gait speed is the 6th vital sign, right alongside temperature and respiration rate. It can predict survival in patients above the age of 65, as well as show damaged health. Walking requires energy and movement control. It also relies on the support of the heart, lungs, and musculoskeletal systems. Walking speed can thus be a warning sign for issues that could reduce survival in the elderly.
Another factor to take into consideration is pressure. Measuring pressure across the foot can help show deformities in the feet. These increase with age and can increase fall risks. Pronation of the foot can increase with age as medial contact of the midfoot and medial displacement of the center of pressure increase. Through monitoring pressure, we can detect these issues.
A third factor is balance. Balance changes with age. The inner ear, eyes, proprioception, feet sensation, and the brain, all work together to maintain balance. With age, these systems decline and can lead to increased falls in the elderly. To be more specific, it was shown that vibration perception thresholds (measure of sensation) and proprioception in the feet decline with age. This thus reduces balance, postural sway, and stability, leading to falls. Another important factor in fall prevention would be muscle reflex. The skin stimuli’s ability to cause muscle reflexes also declines with age. The last factor associated with aging is an increased prevalence of peripheral neuropathy. All these factors contribute to increased risks of falls in the elderly.
So how can we prevent falls in the elderly, using all the parameters discussed above?
To assess the number of falls in the elderly, it is recommended to ask them how many times they have fallen in the last 6 months. But falls stay underreported. Ways to assess fall risks are through gait, pressure monitoring, and haptic vibration.
To assess fall risk and prevent it, a focused history is essential. Details of the fall, its circumstances, factors, and consequences are all relevant. Following that, gait, balance, lower limb, and joint function testing will allow a comprehensive geriatric assessment. Blood pressure, vision, feet and footwear ought to be checked as well. All this is quite unrealistic for healthcare providers to do on a regular basis.
Subsensory and suprasensory vibrations can prevent falls in the elderly. How so? By allowing the foot to better sense the ground. Subsensory vibrations increase the likelihood of you sensing the floor whilst suprasensory vibrations enhance floor sensation. Improved stability and fall reductions have been shown in amputees, Parkinson’s patients, and stroke disease patients, as well as in healthy elderly and young adults.
Falls can also be prevented with the help of step-synchronization. Vibrations can actually improve balance more efficiently when they are step-synchronized.
Path Feel can be a big help to healthcare professionals. By identifying the risks of falls in their elderly patients, they can decrease the number of falls and increase the survival rate. By measuring pressure, gait, and balance, Path Feel is an important factor in fall prevention. By monitoring a wide range of balance and gait parameters, the person’s general health and fall risks are measured. It can thus detect falls. The person’s gait is measured by:
Cadence
Walking speed
Gait cycle time
Stance
Stance loading
Stance foot flat
Support base
Pressure loads across the foot
Pressure distribution over time
Stance pushing
Swing
Double support time
Stride length
Full walking distance
Stride velocity
Posture differentiation (sitting, standing, walking)
Peak pressure
Gait speed
Horizontal shear
Peak angle velocity
Max swing speed
Turning angle
Lift-off angle
Swing width
3D path length
Centre of Pressure (COP)
Postural Sway
Ground reaction force (GRF)
Rotational force (torque)
Path Feel encompasses many unique benefits. As an insole, it is able to measure foot pressure. This gives the Path Feel app a wide array of information that Fitbit and other smartphone apps cannot provide.
Gait changes that have declined due to age can be monitored by Path Feel as well. Whether they are temporal, spatial, or pertain to variability, they contribute to fall risk in the elderly. Path Feel can therefore compare the user’s score to the age norm and flag up concerns that could prevent falls.
Because Path Feel is an insole, its Unique Selling Point is its ability to sense changes in foot pressure, enable step synchronization, and provide vibrations to reduce to postural sway.
With all this insight, users and healthcare professionals can spot fall risks in elderly patients and intervene. From medical intervention, to exercise recommendations and lifestyle modifications, this can go a long way in preserving elderly patients’ health.
Path Feel insoles measure parameters that lead to fall risk in elderly patients. Providing insights on pressure, gait and haptic feedback play a large role in the prevention of falls. Complete the following form to get the Efficacy of a Haptic Insole in Elderly Patients White Paper.
]]>See the article in Neurology.
]]>