title: Effect of uphill and downhill walking on walking performance in geriatric patients using a wheeled walker.
abstract: BACKGROUND
  Wheeled walkers are recommended to improve walking performance in older persons and to encourage and assist participation in daily life. Nevertheless, using a wheeled walker can cause serious problems in the natural environment. This study aimed to compare uphill and downhill walking with walking level in geriatric patients using a wheeled walker. Furthermore, we investigated the effect of using a wheeled walker with respect to dual tasking when walking level.
  
  
  METHODS
  A total of 20 geriatric patients (median age 84.5 years) walked 10 m at their habitual pace along a level surface, uphill and downhill, with and without a standard wheeled walker. Gait speed, stride length and cadence were assessed by wearable sensors and the walk ratio was calculated.
  
  
  RESULTS
  When using a wheeled walker while walking level the walk ratio improved (0.58 m/[steps/min] versus 0.57 m/[steps/min], p = 0.023) but gait speed decreased (1.07 m/s versus 1.12 m/s, p = 0.020) when compared to not using a wheeled walker. With respect to the walk ratio, uphill and downhill walking with a wheeled walker decreased walking performance when compared to level walking (0.54 m/[steps/min] versus 0.58 m/[steps/min], p = 0.023 and 0.55 m/[steps/min] versus 0.58 m/[steps/min], p = 0.001, respectively). At the same time, gait speed decreased (0.079 m/s versus 1.07 m/s, p < 0.0001) or was unaffected.
  
  
  CONCLUSIONS
  The use of a wheeled walker improved the quality of level walking but the performance of uphill and downhill walking was worse compared to walking level when using a wheeled walker.
authors.affiliation: Department of Geriatrics and Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany. ulrich.lindemann@rbk.de.|Research Initiative Human Factors in Ageing, Technology and Environment, University Stuttgart, Stuttgart, Germany. ulrich.lindemann@rbk.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lindemann
authors.affiliation: Department of Geriatrics and Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.|Network on Aging Research, University of Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwenk
authors.affiliation: Research Initiative Human Factors in Ageing, Technology and Environment, University Stuttgart, Stuttgart, Germany.|Institute of Sports and Movement Science, University of Stuttgart, Allmandring 28, 70569, Stuttgart, Germany.
authors.forename: Syn
authors.initials: S
authors.lastname: Schmitt
authors.affiliation: Research Initiative Human Factors in Ageing, Technology and Environment, University Stuttgart, Stuttgart, Germany.|Institute for Automation and Software Engineering, University of Stuttgart, Pfaffenwaldring 47, 70569, Stuttgart, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Weyrich
authors.affiliation: Research Initiative Human Factors in Ageing, Technology and Environment, University Stuttgart, Stuttgart, Germany.|Department of Sport and Exercise Science, Chair Exercise and Health Sciences, University of Stuttgart, Nobelstraße 15, 70569, Stuttgart, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schlicht
authors.affiliation: Department of Geriatrics and Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.|Research Initiative Human Factors in Ageing, Technology and Environment, University Stuttgart, Stuttgart, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Becker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000534:rehabilitation*; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D016032:Randomized Controlled Trials as Topic; D014853:Walkers; D016138:Walking
keywords: Downhill walking; Geriatric patients; Uphill walking; Walk ratio; Wheeled walker