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Ipad Animation Helps Assess Mobility in Elderly

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Wake Forest's Tony Marsh and Jack Rejeski with research subject

Tony Marsh (left) and Jack Rejeski (center) of Wake Forest's Department of Health and Exercise Science teach research subject Reggie Moore how to use an iPad to assess his mobility.

For the one in eight Americans now over the age of 65, mobility is a "vital sign" that should be regularly checked, according to two health and exercise science professors at Wake Forest University.

Mobility is closely linked to overall health and quality of life, but health care professionals have not had an easy and effective way to assess it.

To solve the problem, Tony Marsh and Jack Rejeski developed the Mobility Assessment Tool (MAT) with the help of colleague Yue-Ling Wong in the computer science department and Professor Eddie Ip of Wake Forest University Baptist Medical Center.

The MAT is a unique way to assess mobility in older adults using video animation rather than written questions. Created for the iPad and the PC, the MAT takes about four minutes to complete. The score provides information that helps older adults better understand their current mobility and can provide a yardstick to monitor changes in how well they get around.

Using an iPad or PC, older adults watch short videos of animated figures performing everyday tasks such as climbing stairs or walking while carrying a bag of groceries. The videos help senior citizens picture themselves doing these tasks. They then use the touch screen to indicate what they can and cannot do.

View an animated video that helps individuals assess their ability to walk on uneven ground.

Marsh and Rejeski say the MAT is a quick, simple and cost-effective way to accurately measure mobility and may help practitioners plan appropriate interventions to remediate limitations. They envision the elderly getting "activity prescriptions" to improve their physical function based on the results of the Mobility Assessment Test. The MAT could easily be administered in the waiting room before a patient talks to the physician.

The MAT offers some advantages over written questionnaires and can be used when actually having the older adult perform each task is not possible or practical.

"In pilot testing, we found that the animation technology allowed older adults to project themselves into the tasks," Marsh says. "This removed potential biases that would have occurred if actual people had been filmed doing the tasks."

Using animation instead of actors also made the tool more adaptable and less expensive. In addition, the touch screen technology dramatically decreases the time of test taking.

The authors say that the animation technology allows for great flexibility in altering the form, speed, and environmental parameters of mobility-related tasks, opening up a wide range of possibilities for future research questions.

"This is a tool that could be used quickly in a physician's office or out in the field," says Rejeski, who has found the MAT to be useful in his research on older adults and mobility.

Marsh and Rejeski have recently published two studies supporting the video animation tool's effectiveness in measuring mobility and they have presented their findings at a recent Gerontological Society of America conference. The MAT will be used by researchers involved in the LIFE study, a major multi-year project funded by the National Institutes of Health that is designed to determine the effects of physical activity and successful aging interventions on major mobility disability. Recently Marsh and Rejeski have been asked to collaborate in a cross-cultural study of mobility in older adults with researchers from Canada, Brazil and Columbia that will use the MAT.




It would be great if self-tools for assessing mobility were available so people can better communicate with their doctors. When asked if you can walk X amount of distance by a physician, an answer if "I'm not sure" or "That depends on how I'm feeling" isn't very helpful to the doctor.
Also, it can be embarrassing for a patient to have to admit that they aren't getting around as easy as they used to be, are having problems with mobility, incontinence, memory, etc.
There are a lot of worries that go along with mobility as well. When mobility starts to become difficult, it is easier to discuss, some days better than others. A patient that has been sent to physical therapy repeatedly for years, or may have even asked for it, yet grow tired of the pain it causes, and thus minimize the pain they are in because they don't want to be sent into yet another fruitless physical therapy session. All too often, persons with declining health are embarrassed that they can't afford a medication, and the pressure has increased as more medications are put OTC, and thus are no longer covered by insurance.

For instance, (and this is a true story) A patient had been vomiting after a procedure, profusely. She called the doctor's office to get a prescription for an antiemetic, or advise on weather she should come in, yet lives a ways from the office & the thought of having to walk when she got there, after arranging a ride, etc. was more than she could bear on her very painful leg. The doctor called in the prescription, and the pharmacy informs her that it's not covered by her insurance. She calls the doctor's office again, apologetically (knowing it's more of the doctor's time & hears the annoyed tone of the person on the other end of the phone) to tell them what the pharmacist told them, that that dosage isn't covered by her insurance. The young gal at the doctor's office said the WORST THING someone on a fixed income, barely getting by can hear, "We'll it's not THAT expensive! It's only $30!" As the patient held back her tears, she just said, "OK, sorry to bother you", then went on vomiting off and on for months, as she couldn't afford the medication and eat, until it became intolerable, then told the doctor that she's still vomiting. The doctor wonders why the patient didn't say anything & the patient felt terribly embarrassed that she hadn't told the young gal in that phone call words she simply couldn't utter, words such as "I can't afford $30!", so she suffered & cried alone.

It is often just as hard for an adult to admit they they are having yet one more health issue, as it is to tell their doctor they are having an incontinence problem.Being evaluated "on the spot" can be intimidating, as well as embarrassing, leaving a patient feeling like they are in even less control of their health issues, and lead to avoidance of talking about it, even with their health care provider.

Patients need to be empowered by having tools, such as this iPad app (only you have to remember that many older adults aren't very adept at the use of cell phone or tablet apps, even if they do own a smart phone.)

For many older, or even disabled adults, being presented with one more computerized application is not only difficult for them to relate to, but may also another missed opportunity, and disconnect from that "human connection", depending on how it is used. If used to engage the person, to get them involved and NOT as a "This is how you should walk" (No one walks like the video exactly & most people don't see themselves walking on terrain, even if they might relate to the software, unless they've seen a video of themselves walking up terrain, and even less so if they are more or less house-bound, which few will want to admit if they lived a very activ life and no longer do.

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