Measuring Gait Parameters from Structural Vibrations.

Measuring gait parameters (e.g. speed, cadence, step duration) accurately is invaluable for evaluation during treatment of older adults who struggle with disability onset, disease progression, balance, and injurious falls. Traditionally stopwatches or timing gates are used to measure gait speed in clinical settings, and these are limited to measuring gait speed. Other wearable and non-wearable technologies offer the ability to measure additional gait parameters though patients are known to walk differently with the devices and even tend to slow down before engaging with a non-wearable such as a floor mat. Floor vibrations are a promising option to measuring gait parameters while not being intrusive and not requiring line-of-sight to the patient for measurements. This paper presents methodology for extracting gait parameters using vibrations with comparisons to APDM Wearable Technologies Mobility Lab sensors and stopwatch measurements. Performance is examined across 97 participants for self-selected speed forward, full speed forward, and backwards walks at three different testing sites for a total of 1039 walks. Gait speed vibrations measurements demonstrated excellent reliability with APDM Mobility Lab (ICC: 0.98; 99% CI: 0.01±0.01 m/s) and stopwatch (ICC: 0.97; 99% CI: -0.01±0.01 m/s) measurements. Similar excellent results are reported for cadence, gait cycle duration, step duration, and stride length parameters.

Seniors' and physicians' attitudes toward using driving simulators in clinical settings.

ABSTRACT Interactive driving simulators may offer a safe and controlled environment for occupational therapists to treat clients with conditions that affect their ability to drive safely. The use of simulators has been mostly limited to research settings. To make appropriate use of this technology, identifying and understanding the needs of clients and medical personnel that simulators can fulfill is important. The current investigation seeks to identify the attitudes of potential clients and physicians regarding the use of driving simulators. Using survey and interview methodology, clients' and physicians' needs in regard to driving and community mobility are investigated in the context of identifying potential applications for simulator technology. In addition, general needs and attitudes about driving in the context of medical practice were identified. Attitudes toward the use of simulators were generally positive, and the desire for a greater ability to understand and treat clients in the context of driving appears strong.

Geriatric content in medical school curricula: results of a national survey.

Despite recent gains in establishing academic sections, divisions, and departments of geriatrics in medical schools, much remains to be done to meet the medical needs of an aging population. To better understand how medical schools are educating students in geriatric-related topics, all U.S. allopathic and osteopathic medical schools were surveyed in two waves, in 1999 and 2000, using a questionnaire based on recommendations from the Education Committee of the American Geriatrics Society. Responding schools were more likely to address diseases and conditions of aging, psychosocial issues, and ethical issues and less likely to cover anatomic changes, nutrition, knowledge of healthcare financing, outcome measurement, and cultural aspects of aging. Although limited, the results indicate that medical schools have increased coverage of aging-related material, although further expansion of geriatric content will be necessary to meet the needs of an aging society.

Geriatrics training and education for nongeriatrician faculty: the Dean's Faculty Scholars in Aging Program.

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.

In situ monitoring of health in older adults: technologies and issues.

With the upcoming reform of the healthcare system and the greater emphasis on care in the home and other living environments, geriatric providers will need alternate ways of monitoring disease, activity, response to therapy, and patient safety. Current understanding of the dynamic nature of chronic illnesses, their effects on health over time, and the ability to manage them in the community are limited to measuring a set of variables at discrete points in time, which does not account for the dynamic interactions between physiological systems and the environments of daily life. Recent developments of sensors, data recorders, and communication networks allow the unprecedented measurements of physiological and sociological data for use in geriatrics care. This article identifies and discusses the important issues regarding the use of monitoring technologies in elderly patients. The goals are fourfold. First, some emerging technology that may improve the lives of older adults and improve care are highlighted. Second, the possible applications of technology in geriatrics settings are discussed, with a focus on acute falls, dementia, and cardiac conditions. Third, real and perceived concerns in using monitoring technology are identified and addressed, including technology adoption by elderly people; stigma; and the reduction in social contact; ethical concerns of privacy, autonomy, and consent; concerns of clinicians, including information overload, licensure, and liability; current reimbursement schemes for using technology; and the reliability and infrastructure needed for monitoring technology. Fourth, future approaches to make monitoring technology useful and available in geriatrics are recommended.

Age-related relative volume preservation of the dominant hand cortical region.

Aging is usually associated with a progressive difficulty in learning new skills. Similarly, the dexterity in the non-dominant hand is usually decreased with age, while the dominant hand maintains a relative preservation in agility. We investigated if age-related volume loss affects the hand areas asymmetrically by comparing structural measures of the dominant hand area versus the non-dominant area. We performed a region of interest analysis of T1-weighted images focusing on the sensorimotor cortex corresponding to the hand area. We evaluated images from young subjects (younger than 65 years of age, n=38, mean age=24+/-7 years) and senior subjects (65 years or older, n=61, mean age =73+/-6 years). We observed that older adults exhibited greater leftward gray matter asymmetry of sensorimotor cortex, due in large part to more pronounced age-related loss of gray matter in the right hemisphere. These results are consistent with evidence that disuse leads to atrophy and suggest that age-related declines in gray matter, and perhaps function, may be limited by increasing the use of the non-dominant hand.

Cognitive performance and neural correlates of detecting driving hazards in healthy older adults.

BACKGROUND/AIMS: In spite of the growing number of seniors who drive and their relatively frequent involvement in accidents, little is known about the cognitive substrates of road hazard recognition and their relationship with general cognitive performance in this population. We aimed to investigate, using a combination of functional MRI (fMRI) and a comprehensive neuropsychological battery, the anatomical and cognitive components of driving hazard recognition. METHODS: Fourteen healthy active drivers aged between 65 and 87 years underwent neuropsychological evaluation and fMRI scanning. fMRI was performed while subjects watched a video composed of clips of driving hazards randomly interspersed with uneventful driving clips. We investigated brain areas that are recruited for hazard detection, in contrast to brain areas responding to driving without a hazard. The performance on neuropsychological tests was then regressed with the degree of activation of cortical areas related exclusively to detecting hazards. RESULTS: Driving hazards generated significant activations, compared to non-hazards, in the lateral associative occipital cortex and in the right prefrontal cortex. Intensity of brain activation was correlated on performance on memory and cognitive control neuropsychological tests. CONCLUSION: Future studies can possibly address the same relationship in early dementia, as a preliminary form of investigation for driving safety.

Web-based framework for improving geriatric education.

Despite the growth in the elderly population, physicians with special geriatric training and certification number only 9,000 out of 650,000 doctors in the United States. The flexibility and increasing availability of the Internet makes it an ideal avenue for addressing the educational needs of health care providers to improve the health and care of older adults. We performed an Internet search using popular search engines. This yielded between 321 and 358,000 websites about geriatrics and 164 to 175,000 about geriatric education. This paper reviews popular health and medical Web sites to determine geriatric educational content and proposes a structure for an "ideal" geriatric Web site that would provide resources and enhance training for allied health professionals, physicians in training and community doctors in practice. We also propose a framework addressing the design and content for developing a geriatric specific website. We use this framework to propose a prototype resource on falls and gait instability.

Assessing geriatrics in undergraduate medical education: two different approaches.

Most medical schools do not have a separate course in geriatrics, but rather incorporate geriatrics into existing courses. Tracking and assessing curriculum content is more difficult in this setting. This paper describes and compares two approaches to assess curriculum content in geriatrics: a survey of course directors and a course objectives review. The results suggest that course directors report more geriatric content when asked as part of a regular survey than they identify as specific course objectives. Course objectives may be more reflective of the actual emphasis placed on aging-related material in courses. These two approaches appear to be complementary. Medical educators may find both self-report and course objective analysis to be useful and complementary in tracking geriatric material in the undergraduate medical curriculum.