Assessment of a Robotic Walker in Older Adults With Parkinson's Disease in Daily Living Activities

Abstract

The constant growth of the population with mobility impairments, such as older adults and people suffering from neurological pathologies like Parkinson's disease (PD), has encouraged the development of multiple devices for gait assistance. Robotic walkers have emerged, improving physical stability and balance and providing cognitive aid in rehabilitation scenarios. Different studies evaluated human gait behavior with passive and active walkers to understand such rehabilitation processes. However, there is no evidence in the literature of studies with robotic walkers in daily living scenarios with older adults with Parkinson's disease. This study presents the assessment of the AGoRA Smart Walker using Ramps Tests and Timed Up and Go Test (TUGT). Ten older adults participated in the study, four had PD, and the remaining six had underlying conditions and fractures. Each of them underwent a physical assessment (i.e., Senior Fitness, hip, and knee strength tests) and then interacted with the AGoRA SW. Kinematic and physical interaction data were collected through the AGoRA walker's sensory interface. It was found that for lower limb strength tests, older adults with PD had increases of at least 15% in all parameters assessed. For the Sit to Stand Test, the Parkinson's group evidenced an increase of 23%, while for the Chair Sit and Reach Test (CSRT), this same group was only 0.04 m away from reaching the target. For the Ramp Up Test (RUT), the subjects had to make a greater effort, and significant differences (p-value = 0.04) were evidenced in the force they applied to the device. For the Ramp Down Test (RDT), the Parkinson's group exhibited a decrease in torque, and there were statistically significant differences (p-value = 0.01) due to the increase in the complexity of the task. In the Timed Up and Go Test (TUGT), the subjects presented significant differences in torque (p-value of 0.05) but not in force (p-value of 0.22) due to the effect of the admittance controller implemented in the study. Finally, the results suggested that the walker, represents a valuable tool for assisting people with gait motor deficits in tasks that demanded more physical effort adapting its behavior to the specific needs of each user.

Keywords: Parkinson's disease; daily living activities; older adults; senior fitness; smart walker; timed up and go.

Figure 1

AGoRA Smart Walker (SW) description.

Figure 2

Description of the system architecture implemented in this study.

Figure 3

Illustration of experimental setups of the daily living activities part. (A) Ramps test setup. (B) Timed Up and Go test (TUGT) setup.

Figure 4

Summary of the protocol and experimental tests performed by the older adults to evaluate their performance within the study.

Figure 5

Illustration of the results obtained for the SFT. • indicates that there were significant differences between the groups evaluated. (A) Sit to Stand Test (SST). (B) Arm Curl Test (ACT). (C) Chair Sit and Reach Test (CSRT). (D) Back Scratch Test (BST). (E) Six Minutes Walking Test (6MWT).

Figure 6

Illustration of the kinematic and physical interaction data obtained for the three tests. Where RUT is Ramp Up Test, RDT is Ramp Down Test, TUGT is Timed Up and Go Test, Parkinson group (PK) corresponds to the group of older adults with Parkinson's disease (PD) and MJF the group with metabolic and joint diseases and fractures. • indicates that there were significant differences between the groups evaluated. (A) User Speed. (B) SW Speed. (C) Cadence. (D) Cycle Duration. (E) No. Cycles. (F) Trial Duration. (G) Max frc_y. (H) Mean frc_y. (I) Max trq_z. (J) Mean trq_z.

Figure 7

The behavior of the results obtained for walker speed. PK stands for older adults with Parkinson's disease and MJF stands for a group of older adults with base, joint and fracture diseases. (A) Ramp Up Test. (B) Ramp Down Test. (C) Timed Up and Go.

Figure 8

The behavior of the results obtained for force. PK stands for older adults with PD and MJF stands for a group of older adults with base, joint, and fracture diseases. (A) RUT. (B) RDT. (C) TUGT.

Figure 9

The behavior of the results obtained for torque. PK stands for older adults with PD and MJF stands for a group of older adults with base, joint, and fracture diseases. The areas highlighted in gray represent the times when the turns were presented and the area highlighted in black represents the time when the subjects were leaning on the device to stand up and initiate the test. (A) RUT. (B) RDT. (C) TUGT.