Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages.

Falls are a significant public health problem with serious consequences. Fall related consequences have the potential to drastically and negatively impact the quality of life of patients who fall, and the care for fall patients is already putting a significant strain on the health care system. Advanced age has long been associated with falls. The fraction of the population represented by those of such an advanced age is increasing rapidly, subsequently the number of persons at risk for falling is also rapidly increasing. While advanced age is non-modifiable, there are many risk factors for falls which can be modified to potentially and ideally decrease the prevalence of falls. Physical inactivity is one such risk factor. Efforts to increase the amount of physical activity performed by a population at risk of falling could reduce number of falls in that population, and in turn could reduce the negative impact of fall related consequences in that population and have significant public health benefits. A particular set of exercises called the Otago exercise has already demonstrated efficacy at reducing fall rates in the elderly. Prior studies of the Otago exercise program were limited by poor compliance. There is evidence that behavioral interventions, particularly social cognitive theory, can be an effective means of increasing compliance with recommended physical activity regimens. Smartphones have the potential to be used as more cost effective means of delivery for social cognitive theory. The effectiveness of such a strategy has not been evaluated in the elderly population at risk for falling however. The following proposal is for a randomized controlled trial to investigate the effectiveness of a smartphone application designed to utilize the principles of social cognitive theory to increase compliance with the Otago exercises in an elderly population at risk of falling compared to the standard delivery of the Otago exercise. Patients from the Boston Medical Center geriatric practice will be enrolled to the protocol. Outcomes will include compliance with the prescribed exercises, falls, and engagement with the application.

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Water World is a water reservoir in the shape of a mountain, with a steel grid body and a shell of shot concrete. It is situated in the national city park Lill-Jansskogen in Stockholm and the emergence of this project is the disrepair of an existing reservoir. Humans, like all things alive, are dependent on water. We survive approximately three days without water. The stored water is the start of civilization, the first of all functions in society we would not cope without in case of collapse. Instead of habitually reshaping nature in accordance with our needs and wishes, this reservoir mimics nature with synthetic means. It questions the idea that we by technical means could create an equilibrium between nature and late capitalist society. Our systems handling water enables modern life. Water World celebrates this function, and life. After construction the man-made surface is exposed to decay and with time the interior structure will stand as a ruin marking the end of the era of globalisation. / Water World är en vattenreservoar inkapslad i ett konstgjort berg, med en stomme av stål och ett yttre av betong. Reservoaren är belägen i Lill-jansskogen i centrala Stockholm, Sveriges enda nationalstadspark. Människan liksom alla levande varelser är beroende av vatten för sin överlevnad. Vi överlever ca tre dagar utan vatten. Det lagrade vattnet är början påcivilisationen, den första av samhällets funktioner vi inte skulle klara oss utan vid en eventuell kollaps. Istället för att vanemässigt forma naturen efter våra behov och önskningar försöker reservoaren efterlikna naturen med syntetiska medel. Den ifrågasätter idén om att vi med teknikens hjälp kan skapa en balans mellan natur och vår senkapitalistiska kultur. De system människan har utvecklat för att lagra vatten möjliggör våra moderna liv. Water World hyllar denna funktion, och livet. När konstruktionen är färdig kommer den av människan formade ytan med tiden förfalla och interiörens struktur lämnas som en ruin att markera slutet av eran av globalisering.

Background and Purpose: The adverse effects of drugs may influence results on tests of mobility and balance, but the drug-specific impact is not identified when using these tests. We propose that a quantitative drug index (QDI) will assist in assessing fall risk based on these tests, when combined with other fall risk variables. Methods: Fifty-seven community-dwelling older adults who could walk independently on a treadmill and had Mini-Mental State Examination (MMSE) scores equal to or greater than 24 participated. Mobility and balance outcome measures included the Balance Evaluation Systems Test (BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) and cognitive dual task TUG (TUGc). Fall history, current drug list, and Activity-Specific Balance Confidence (ABC) scale scores were also collected. Body mass index (BMI) was calculated. The QDI was derived from the drug list for each individual, and based on fall-related drug adverse effects. Multiple linear regression analyses were conducted using age, BMI, and QDI as predictor variables for determining mobility and balance test scores, and ABC scale scores. Subsequently, participants were divided into (QDI = 0) low-impact drug group (LIDG) and (QDI > 0) high-impact drug group (HIDG) for Mann-Whitney 2-group comparisons. Results: Age, BMI, and QDI were all significant (P <.001) independent variables in multiple regression analyses for mobility and balance test scores, but not for the ABC scale. Separately, the 2 group comparisons for the BESTest, BBS, TUG, and TUGc demonstrated that HIDG scored significantly (P <.05) worse on these tests compared with the LIDG. Drug counts were also significantly higher for the HIDG than for the LIDG. In contrast, age, BMI, MMSE, and reported falls in the last 12 months were not significantly different between groups. Conclusion: Age, BMI, and QDI - all contributed independently to the mobility and balance test scores examined, and may provide health care professionals a screening tool to determine whether additional mobility and balance testing is required. In addition, the QDI is a more precise marker of adverse effects of drugs compared with drug counts, as the latter does not quantitate the influence of drugs on physiologic function.

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Indiana University-Purdue University Indianapolis (IUPUI) / Fall in recent years have become a potential threat to elder generation. It occurs because of side effects of medication, lack of physical activities, limited vision, and poor mobility. Looking at the problems faced by people and cost of treatment after falling, it is of high importance to develop a system that will help in detecting the fall before it occurs. Over the year's, this has influenced researchers to pursue the development to automatic fall detection system. However, much of existing work achieved a hardware system to detect pre and post fall patterns, the existing systems deficient in achieving low power consumption, user-friendly hardware implementation and high precision. Growth in medical devices can be seen in recent years. Today's medical devices aim to increase the life expectancy and comfort of human being. The systems are designed to be made reliable by improving the performance, optimizing the size and minimizing the energy consumption. For wearable technologies, power consumption is an important factor to be considered during system design. High power consumption decreases the battery life, which leads to poor comfortability. The purpose of this research is to develop a system with low power consumption to detect human falls before they happen. This research points towards the development of dependable and low power embedded system device with easy to wear capabilities and optimal sensor structure. In this work, we have developed a device using motion sensor to sense the subjects linear and angular velocity, communication sensor to send the fall related information to caretaker, and signal sensors to communicate and update user about device information. The designed system is triggered on interrupts from motion sensor. As soon as the system is triggered by an interrupt signal, users balanced and unbalanced states gets monitored. Once the unbalanced state is designated, the system signifies it as fall by setting a fall flag. The fall decision parameters; pitch, roll, complementary pitch, complementary roll, Signal Vector Magnitude (SVM), and Signal Magnitude Area (SMA) are layered to classify subject's different body posture. This helps the system to differentiate between activity of daily living (ADL) and fall. When the fall flag is set, the device sends important information like GPS location and fall type to caretaker. Early fall detection gives milliseconds of time to initiates the preventive measures. The system was designed, developed, and constructed. Near 100% sensitivity, 96% accuracy, and 95% specificity for fall detection were measured. The system can detect Front, Back, Side and Stair fall with consumption of 100_A (650_A with BLE consumption) in deep sleep mode, 6.5mA in active mode with no fall, and 14.5mA, of which 8.5 mA is consumed via the BLE when fall is declared in active mode. The power consumption was reduced because the integrated wireless communication devices consumed power only when the fall is triggered, giving the device a potential to communicate wirelessly.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is considered a rare autoimmune disorder which makes it difficult to accurately diagnose and creates a lot of opportunity for active research. With its wide array of presentations and even similarities to other neurological disorders, improvement must be made in the field of diagnostic methods in order to offer concise and effective treatments. As with many other neurological disorders, CIDP patients are at a higher risk for falls. The dual effect of gait impairment due to neuropathy and general effects of older age create a dangerous combination and increase the risk for falls. By increasing the accuracy with which physicians and health professionals predict falls in patients, they can effectively prevent serious injury and improve quality of life. Consequently, in order to predict the risk of falls, and therefore prevent severe injury, the ability to accurately access the specific qualities of the patient’s gait is critical. Without the ability to precisely identify patients’ particular gait impairment presentation it is very difficult to establish their risk for falls. The current methods of diagnoses focuses mainly on PROs (patient reported outcomes) which are often gathered through patient questionnaires. Previous research has shown that such methods are simply not detailed and patient specific enough to offer a complete picture of a patient’s condition. We believe ProtoKinetics Movement Analysis Software (PKMAS) is an objective, examiner independent measure of patients’ gait, and offers a method of quantifying patients’ functional gait outcomes in a way that is superior to the current standard of care procedures. Therefore, in this study we aim to reveal the shortcomings of current standard of care procedures in the diagnosis and treatment of CIDP, while also demonstrating the superior value of PKMAS in providing a detailed patient disease profile for CIDP afflicted individuals. Specifically, we demonstrate PKMAS’ increased ability to predict fall risk in CIDP patients, as compared with currently used methods. In this study PKMAS data was collected under two conditions: Dual Task and PWS (preferred walking speed). During each condition the patient was asked to walk across the Gait Map/Zeno Walkway as the ProtoKinetics Software collected detailed information about the patients’ gait. For PWS, patients were asked to walk across the map at a speed they were most comfortable at as PKMAS data was collected. For Dual Task, patients are asked to walk at their preferred walking speed while simultaneously doing a simple cognitive task, for instance, counting backwards from a hundred. This second condition is particularly important. The point of such a task is to mimic real-life walking. When we walk on a daily basis we are usually thinking or doing something else simultaneously, even if we may not be consciously aware of this. As such, comparing the results for PWS and Dual Task for patients can shine light onto their real-life gait experience. In order to do so, we measured the percent change in abilities between PWS and Dual Task walking. A greater change signifies greater gait impairment, and a change of greater than 15% places the patient at risk for falls. Among the PROs, INCAT is the one most often referred to in neurological standard of care and as such we focused on this particular questionnaire separately as well. To do so, t-tests were completed to demonstrate the lack of validity in scoring, by looking at the PKMAS data as compared between two INCAT scores. In this study we seek to demonstrate the superiority of ProtoKinetics Movement Analysis Software (PKMAS) over the current standard of care for CIDP patients. Specifically, in accurately evaluating patients’ gait and future fall risk. The ability to do so is vitally important for elderly patients who already suffer from decreased gait stability and the additional impact of CIDP can accentuate that risk.

Gait initiation (GI) is an important locomotor transition task that includes anticipatory postural adjustments and the joint propulsion necessary for the first step of walking. Metrics associated with this task are known to change across the lifespan and may provide valuable information for fall risk indication, as falls often occur during transitional tasks. Assessments of discrete variables between fallers and non-fallers at GI have provided insight into differences between groups. However, more complex approaches such as time-series principal component analysis (PCA) may allow the examination of changes in magnitude, pattern, and timing not detectable using discrete comparisons alone. Therefore, this thesis aims to characterize differences between fallers and non-fallers by examining the kinematics and kinetics of gait initiation using time-series PCA. A sample of 56 community-dwelling older adults was recruited for this study and completed five walking trials where GI was measured by two force platforms. PCA of centre of pressure kinematics and kinetics time-series data were used to identify the critical features of the signal, and multivariate analysis of covariance was used to compare the individual loading scores of each principal component for each phase between groups. It was revealed that fallers demonstrated differences in the range of mediolateral movement during weight transfer and forward progression, a greater range of anteroposterior movement in forward progression, and a more gradual rise in vertical forces in the first step, associated with a shorter first step length. These findings point to a tendency for fallers to prioritize stability over forward progression performance, and differences in postural control strategies, compared to non-fallers. Further, the use of time-series PCA helped to highlight differences not detectable using discrete analysis alone. / Graduate