Complete Mobility Assistance Technology
For hundreds of years canes and walking sticks have been used to provide mobility assistance to those suffering from chronic injury, cognitive disability or illness, as well as to prevent falls. Over time, the basic design of mobility assistance technology has changed very little, despite design issues that have been found to cause minor, or even sometimes, severe injury. In fact, about 47,000 elderly people are injured every year from cane or walker related falls, according to a Center for Disease Control and Prevention report. In addition to falls, injuries have also been reported from repetitive strain or cumulative trauma disorder due to improper use and fit of canes. Each year 35 to 40 percent of older adult Americans will fall at least once and the medical costs of treating those fall injuries are estimated at $26 billion per year. At this time, researchers are seeking means to further reduce risk factors for adults who utilize canes and walkers by identifying potential design problems.
Description of technology
The aPallo cane is an example of current technology addressing the issues of outdated cane design. Created by orthopedic surgeon Dr. Palo, the aPallo mobility assistance technology addresses the hazards and limitations related to outdated walking device models, providing updated technology that allows a full cycle of mobility, from sitting to standing to walking. The first of its kind, the aPallo cane features a second handle located below the upper handle, to safely assist the user when rising from a sitting position.
The cane’s primary handle is soft foam and placed at a slight downward angle to increase leverage benefits and reduce soft tissue injury commonly found in cane users accrued from repetitive movement and strain, as well as fall risks.
People who utilize walking assistance technology commonly do so due to temporary or permanent injury, cognitive illness or other poor health related issues. Lessened strength and balance are common ailments and the difficulties experienced when rising from a seated or prone position are one of the most common complaints of cane and walker users. The aPallo cane’s lower handle is ergonomically designed for both comfort and security with a soft grip, slip-proof handle. The cane height is fully adjustable. Many cane-related injuries have been linked to incorrect cane fitting in relation to the user’s size. It is recommended that users either seek the advice of a physician to assure correct height requirements for size and weight, or follow chart requirements such as those found on the aPallo website.
In addition to the angled arm and second handle, aPallo canes feature a high-intensity LED light easily accessed for nighttime maneuverability. With increased age, many men suffer from benign prostatic hyperplasia or BPH, which is characterized by the formation of large nodules in the periurethral region of the prostrate. The urethral canal obstruction causes urinary hesitancy, frequent urination and sometimes painful urination. An estimated 50 percent of men have histologic evidence of BPH by age 50 and 75 percent of men show evidence by age 80. Of the men and women ages 30-70 who awaken during the night to use the bathroom, more than one-third get up twice or more each night to urinate, fitting the clinical diagnosis of nocturia. The need for frequent toileting and/or the urgency to void increases the risk of falls for the elderly by as much as 26 percent, and bone fracture by as much as 34 percent. The aPallo technology’s high intensity light illuminates a pathway-width swath of light that prevents injury at any location, be it a late-night bathroom trip or navigating a unlevel sidewalk on an evening stroll. The increased illumination without the necessitation of reaching for a light should decrease accidents and injury of nocturia patients.
Disclaimer and limitation
This device does not prevent, treat or cure a medical condition. The information contained in this memorandum has been gathered from several sources therefore there is no warranty expressed or implied as to the completeness and or accuracy in this memorandum. No device can prevent falling injuries and any person using this technology should check first with their physician to determine if it’s appropriate for their mobility needs.
It is clear there is a great need for improved quality of life for the elderly and the temporarily or permanent injured who have compromised mobility. Mobility assistance technology has remained the same for hundreds of years despite the many design flaws in canes, walking sticks and walkers of day past.
To address this issue, the Centers for Disease Control and prevention completed a study on falls and traumatic brain injury. The results of the study were published in the April 4, 2003 issue of “Morbidity and Mortality Weekly Report,” and it stated there were 26,761 traumatic brain injuries (TBIs) that required people to be hospitalized between 1996 and 1999 in California. Of these cases, 1,752 people died. Of those who died, 71 percent were more than 65 years old. Researchers concluded there were multiple reasons older adults constituted the highest percentage of deaths in the study.
Elderly people are more often hospitalized because they suffer from, or are reaching more advanced states of diseases such as Parkinson’s or osteoarthritis, which can increase the likelihood of falls. Many elder adults take medications that may make them dizzy or drowsy, and some may have impaired balance and weaker muscles. These factors may all contribute to more frequent and serious falls. TBIs are not the only problem the elderly face when they fall. Broken bones are a frequent consequence and fear of falling may make the elderly less active, which also causes poor consequences, including reduced blood circulation and further weakness.
People over age 65 also have a very high rate of brain injury due to falls. In fact, falls are the leading cause of brain injury in the elderly with traumatic brain injury occurring in 46 percent of fatal falls among older adults.
People ages 70 and older also have the highest pedestrian fatality rates, accounting for approximately 18 percent of total pedestrian totalities according to NHTSA. The second-highest pedestrian fatality rate includes individuals aged 55 to 64 years. Factors contributing to these high casualty rates include the physical impairments of many elderly walkers and accidents that took place in the dark or poorly lit areas.
About 20 to 30 percent of people who fall suffer moderate to severe injuries such as bruises, hip fractures or head traumas. The most common fractures are of the hip, spine, forearm, leg, ankle, pelvis, upper arm and hand. Injuries can make it difficult to get around and limit independent living; they also increase the risk of early death. (Scott 1990; Alexander et al. 1992; Sterline et al. 2001).
Mobility assistance technology has a long history. Canes or walking sticks were originally hand carved sticks, some created with beautiful artistry. However, despite the artistic quality of many walking sticks, the hard, slick handles, inability to adjust to the height and weight of the user and other design issues make them poor, ineffective choices for most long term cane users – if not outright dangerous to certain members of the population.
Evidence suggests the outdated design of most canes currently on the market are to blame for large instances of soft tissue damage from repetitive motion strain, injuries accrued from falls due to incorrect height of cane, slippery handle and/or base of cane, and poorly balanced weight of the walking device, which causes further impairment or injury.
Currently there are four basic types of mobility devices on the market that cater to the needs of the elderly or those temporarily or permanently disabled. These devices include the C cane, functional grip canes, quad canes and hemi walkers.
The C cane, which resembles a curved candy cane in shape, is the most common type of walking cane. It resembles a curved candy cane in shape. These canes are available at a variety of retailers, including many pharmacies and drug stores, and are often chosen for use by people who have only a slight, temporary injury or walking impairment. C canes generally feature a rubberized base that helps prevent slipping, but the simple design does not offer much in the way of balance control.
Functional grip canes are aptly named because the straight handle featured in this type of cane provides better balance capabilities to its users. However, aside from the improved grip, C canes and functional grip canes are similar in every other fashion.
The shape of the base in quad canes characterize the biggest difference in design from both C canes and functional grip canes. Rather than a rubberized point, these walking canes have a rectangular base, ending in four points. The points offer increased stability at the base of the cane, which is often an improvement for patients with longer-term injuries or impairments. Quads tend to be more durable than functional grips as C canes as well.
Hemi walker canes differ from quads in that their base is much larger. These canes are often utilized by people moving from a walker to a cane. Hemi walkers are commonly used by people suffering from a permanent injury or condition that affects mobility.
The common cane types mentioned above cover the full spectrum of mobile assistance technology to date, with the exception being the new aPallo technology, which features some basic design similarities as well as the lighting, secondary handle, angled grip, omni-directional ball feature and adjustable capabilities.
Again, to fully understand the changes and additions needed for the greatest mobility possible for cane users, common problems among the user population must first be addressed. Canes or other mobility devices are utilized by individuals who are elderly or disabled and suffer from dizzy spells, cognitive disorders, injury or weakness, as well as those who have temporary or permanent injury that impairs the individual’s ability to rise from a prone position, walk and navigate paths.
As mentioned in the abstract, the Centers for Disease Control and Prevention published a report in 2009 on cane or walker related falls. Despite the fact that the primary function of canes and walkers is to assist mobility and prevent falls, the report found that 47,000 elderly are injured every year from cane or walker-related falls.9 The report said that an average of 129 falls per day or 3 percent of falls among people aged 65 or older could be related to cane or walker usage.
The data came from emergency room statistics across the nation. About 60 percent of the falls occurred at home.
Other key finding included:
For men and women who used walkers or canes, the chances of sustaining a fall increased with age, with the highest injury rates among those ages 85 and older.
Fractures were the most common type of fall injury associated with walkers (38 percent) and canes (40 percent) and about a third of all injuries were to the lower trunk, such as the hip or pelvis.
More than half of fall injuries associated with walkers (60 percent) and canes (56 percent) occurred at home.
One in three people whose fall involved a walker and more than one in four (28 percent) whose fall involved a cane had to be hospitalized.
Source: (2009 Centers For Disease Control and Prevention)
At this time, additional cane technology studies are in process. The goal of these studies is to better understand fall risk factors for older adults who utilize walkers and canes. In doing this researchers will work to identify potential design problems in both canes and walkers.
Falls are the leading cause of nonfatal injury in the U.S. The risk of dying from injuries is increasing for Americans ages 65 and older according to a 2010 report from the John Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy. The report, which found a significant increase in death rates from falls, were published in the February issue of Injury Prevention and are available online at the journal’s website.
Falls aren’t the only danger represented by outdated cane technology. Repetitive strain injury, also known as repetitive stress injury, repetitive motion disorder or regional musculoskeletal disorder is an injury of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces) or sustained or awkward positions. The injury is common in individuals who rely on a cane or other mobility device for movement assistance. In most patients, the pain is in the arm, back, shoulders, wrists or hands. It is worse with activity and leads to increased weakness and lack of endurance.
Cumulative trauma disorders treatment usually includes rest from the activities that caused the problem or a change in work practices. Doctors may prescribe treatments such as a wrist split, anti-inflammatory medications, steroid injections, physical and/or occupational therapy, cold and hot baths or even surgery in advanced cases.
The aPallo technology’s secondary handle is one of several features that addresses these dangerous issues. The updated technology is long overdue, if the above injury research stated above is any indication. And, in many seniors or individuals living with an impairment or illness, the need for independence is as important to quality of life standards as any basic safety standards. Technology such as that of the Apallo cane allows the user to perform the basic tasks necessary for an independent lifestyle – standing, walking and safely navigating a dark room or pathway with ease.
Why stay active? Following a sedentary lifestyle is more dangerous for your health than smoking, a recent study reported in the South China Morning Post. The studied was completed by the University of Hong Kong and the Department of Health. In the study, researchers looked at the level of physical activity in people who died and were able to correlate their level of physical activity with their risk of dying. It was found that 20 percent of all deaths of people 35 and older were attributed to a lack of physical activity. That’s more deaths than can be attributed to smoking.
Looking at specific diseases, the risk of dying from cancer due to lack of physical activity increased 45 percent for men and 28 percent for women. For respiratory ailments, the risk increased by 92 percent for men and 75 percent for women. Heart disease was found to be 52 percent higher for men and 28 percent higher for women when coupled with lack of physical activity.
A recent study published by the American Heart Association found that moderate intensity physical activity, such as walking, is associated with a substantial reduction in risk of total and ischemic stroke.
The human body is simply designed to move about. Moving muscles, ligaments and limbs massages tissues and organs of the body, bringing them oxygen and enhancing their flexibility. Flexibility or lack of flexibility is a key condition in many cane or walker users. Increasing mobility means staying mobile longer.
In 2006, an estimated 145,000,000 U.S. adults (age 20 and older) were overweight or obese. This represents 66.7 percent of the adult population. A sedentary lifestyle is also believed to be a factor in obesity, which has been linked to increased prevalence of Type II diabetes, heart disease and hemorrhoids.
Canes are one of the most basic mobility aids out there and they do a great deal to allow ordinary people to go about their daily lives. Ergonomic and more comfortable handles help spread the pressure and ease the load on the wrist.
A study conducted by government researchers and published in the June of 2009 issue of the Journal of the American Geriatrics Society examined six years of emergency room records, to find the most common issues and ailments among cane and walker users. The following recommendations for cane or walker were published:
The walker or cane should be about the height of your wrists when your arms are at your sides.
When using a walker, your arms should be slightly bent when holding on, but you shouldn’t have to bend forward at the waist to reach it.
Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.
Study suggestions also included some general safety guidelines in the home for cane and walker users. These included
Remove scatter rugs, electrical cords, spills and anything else that could cause a fall.
In the bathroom, use nonslip bath mats, grab bars, a raised toilet seat and a shower tub seat.
Simplify the household by keeping items used daily handy and easy to reach – everything else goes out of the way.
Use a backpack, fanny pack, apron or briefcase to help carry things around.
Another reason many elderly people suffer from fall injuries is related to declining proprioception. Proprioception is the sense or awareness of where you various body parts are in relation to each other. An example of normal proprioception is being able to close your eyes and alternate touching your nose with your right and left index fingers. It’s you internal sense of where your fingers are in relation to your nose that allows you to do that. You also use proprioception when navigating through a dark room without bumping into anything.
Falls account for 25 percent of all hospital admissions, and 40 percent of all nursing home admissions, 40 percent of those admitted do not return to independent living and 25 percent die within a year. Falls are the leading cause of non-fatal medically attended injuries in the U.S. Annually, one in three Americans age 65 or older experience a fall, and many are recurrent. Physical injuries associated with falling include fractures, contusions and lacerations. Hip and lower extremity fractures can be especially debilitating for older adults.
For those adults who have fallen in the past, the fear of repeat falls can lead to greater debilitation. This fear may cause them to limit their activities, leading to further reduced mobility and physical fitness and increased risk of falling again. Many falls do not result in injury, but a large percentage of non-injured fallers (47 percent) can’t get up without assistance.
Technology such as that of the aPallo mobility assistance device offers the next generation of walking tools for individuals suffering from injury, stroke, weakness, cognitive issues or other disabilities that cause an individual to require mobility assistance. The stagnant design advances of canes and walking sticks not only represent decreased mobility for users, but outright danger in many cases due to imbalance, slippery or poorly angled handles and incorrect height and sizing for individual size, weight and needs of users. Path illuminating abilities, swiveling configurations, a secondary handle used for rising from a seated position, adjustable height, and angled upper handle are all cane design updates long overdue for an increasingly vulnerable population.
Jennifer Dean holds a Bachelor of Arts Degree from the University of Redlands, a top ranked private school located in Southern California. Her degree is in education with a focus on English. She is a family health reporter at one of the largest daily newspapers in Southern California. All studies and data used in this report, gathered from a variety of viable sources, were verified for accuracy.