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Browsing Research and Education by Subject "Accidental Falls"
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Item Auditory Navigation in Bilateral Hearing Aid Users(2017-01-17) Chamseddin, Bahir; Shayman, Corey; Lee, Rebecca; Hullar, TimothyINTRODUCTION: Falling is a serious and common problem in the United States and is responsible for the most injuries, fatal and nonfatal, for Americans. Recent data implicates a link between those suffering from hearing loss and increased incidence of falls. Possible reasons include a coexisting reduction in cognitive capacity, reduced vestibular sense, and loss of auditory perception leading to decreased spatial awareness; however, none have been investigated during a walking balance test. This study investigates the ability of hearing aids to reduce veering, a walk that increases risk of falls, in the bilateral hearing aid population. METHODS: Healthy subjects (n=11) with no reported vestibular or auditory pathology and experienced bilateral hearing aid users (n=6) were blindfolded and instructed to walk 8m towards a speaker that emitted broadband white noise. Variables integrated a loud speaker, headphones, and no sound or bilaterally aided, unilaterally aided, and unaided in the healthy and pathologic populations, respectively. Recordings were taken for displacement from the speaker at the end of the runway and distance reached when subjects deviated within 1m from the intended walking path. Users also were instructed to walk normally or heel-to-toe. RESULTS: Using ANOVA analysis, healthy subjects significantly improved navigation during sound trials throughout both walking conditions (P= 0.005 for both tests). Bilateral hearing aid populations benefited from sound during narrow-based walking conditions (P= 0.06), yet during standard walking conditions the final displacement observed between aided and unaided trials were no different (P=0.85). Participants did not report a subjective improvement in balance with maximal sound cues. DISCUSSION: This study suggests that bilateral hearing aid population who do not have excellent familiarity with walking deprived of vision do not benefit from hearing aids to reduce veering during transient low-light conditions, such as getting up at night to use the restroom. The results also suggest differences in localization between normal walking and tandem walking which may have been attributed to sensory compensation, gait velocity, and attention required to keep balance. The reduction in veering with hearing aids in some cases may offer a public-health benefit through avoiding falls in this population. CONCLUSION: Auditory spatial awareness is responsible for the reduction in veering associated with imbalance. This study suggest that bilateral hearing aid population may benefit from hearing aids to walk during conditions in the absence of vision. Additionally, sound beacons can be used to benefit populations outside the blind.Item Gamification of Exercise and Its Application for Fall Prevention Among Patients with Diabetes and Peripheral Neuropathy(2014-02-04) Monier, Elizabeth; Najafi, Bijan; Grewal, Gurtej; Lee-Eng, Jackie; Menzies, Robert; Talal, Talal K.; Armstrong, David G.BACKGROUND: Individuals with diabetic peripheral neuropathy (DPN) often experience concomitant impaired proprioception and postural instability. Diminished peripheral sensory input, as found in DPN, has been associated with an increased risk of falling in elderly diabetics. Conventional balance training often consisting of Tai Chi, physiotherapy, and strength training has demonstrated an improvement in effective balance control for DPN patients, but these conditioning regimens do not provide visual feedback to help compensate for impaired proprioception. METHODS: In a randomized trial study, the efficacy of an innovative game-based balance and proprioception training program for patients with DPN was assessed through direct evaluation of changes in body sway before and after the exercise protocol using body worn sensor technology. Participants were randomized to either intervention or sham groupings. All participants' baseline gait and balance were assessed at the initial visit and again after four weeks. Twice weekly, the intervention group participated in a training regimen based on virtual simulation for a total of four weeks. Postural sway was assessed before and after each training session. The gaming exercise consisted of a series of ankle point-to-point reaching tasks as well as crossing a series of virtual obstacles of varying heights. During exercise training, the body-mounted sensors connected to the created program to produce real-time animation of lower extremity joint position for the participant to view on a computer monitor. RESULTS: Forty-one eligible subjects have been recruited to date; however, the results of 15 participants (Age: 56.3 ± 4.9, BMI: 30 ± 15 kg/m2) who completed the four-week exercise program have been reported. The preliminary results suggest that the active group reduced ankle sway by 76% (2.82 ± 2.8° to 0.66 ± 0.47°), hip sway by 81% (7.96 ± 9° to 1.48 ± 1.2°) and center of mass (COM) sway by 76% (0.69 ± 0.7° to 0.16 ± 0.11°) during eyes open balance assessment. Similar reductions during eyes closed assessments were observed with reductions of 50%, 24% and 45% for ankle, hip and COM sway, respectively. CONCLUSION: This research implemented a novel balance rehabilitation strategy for patients with diabetic peripheral neuropathy based on virtual reality technology that helps compensate for impaired joint proprioception. The method employed body sensors to generate an interactive user interface for real-time visual feedback based on ankle-joint motion, similar to a video game. The study provides evidence that visual illustration of extremity position in an interactive setting coupled with motor control tasks may be an effective rehabilitation method for postural instability in patients with diabetic peripheral neuropathy.