Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer’s Disease: Part II – 4-Wheeled Walker

Abstract

Background:Cognitive deficits and gait problems are common and progressive in Alzheimer’s disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk.Objectives:1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults.Methods:Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones).Results:Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values <0.025). Stride time variability was significantly different between groups for straight path single task (p = 0.045), straight path multi-task (p = 0.031), and Figure of 8 multi-task (0.036). Gait and cognitive task costs increased while multi-tasking, with performance decrement greater for people with AD. None of the people with AD self-prioritized gait over the cognitive task while walking in a straight path, yet 75% were able to shift prioritization to gait in the complex walking path.Conclusion:Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance.

Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia

“…Yet access to rehabilitation is not guaranteed and those who do receive services may have ongoing de cits after completion of an exercise program, so prescription of aids is still an important clinical tool. Adults with dementia newly learning or experienced in using a 4-wheeled walker demonstrate increased cognitive demands and a deterioration in gait in distracting situations and when manoeuvring around obstacles [16]. Additionally, the uptake and safe use of mobility aids may be impacted by cognitive impairment through a lack of self-awareness or incomplete learning to use the equipment safely [6].…”

Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia

“…Yet access to rehabilitation is not guaranteed and those who do receive services may have ongoing deficits after completion of an exercise program, so prescription of aids is still an important clinical tool. Adults with dementia newly learning or experienced in using a 4wheeled walker demonstrate increased cognitive demands and a deterioration in gait in distracting situations and when manoeuvring around obstacles [16]. Additionally, the uptake and safe use of mobility aids may be impacted by cognitive impairment through a lack of self-awareness or incomplete learning to use the equipment safely [6].…”

Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia

“…Therefore, prescription of mobility aids is still an important clinical tool to compensate for de cits. People with dementia newly learning or experienced in using a 4-wheeled walker demonstrate increased cognitive demands and a deterioration in gait in distracting situations and when manoeuvring around obstacles [19,20].…”