Giant steps toward a better understanding of the health of the elderly
Twice Jacqueline Deland has walked the full length of a special carpet in the JGH Mobility Clinic, under the watchful eye of Dr. Olivier Beauchet. Using her walker, she first moved at her usual, comfortable pace, and then, at Dr. Beauchet’s request, retraced her route at a faster clip.
But now the doctor has asked for something that strikes Ms. Deland as odd: He wants her to walk normally along the 10-metre-long carpet, while counting backwards.
“Really?” asks Ms. Deland with a smile. “Backwards?”
“Yes, backwards,” Dr. Beauchet assures her. “Give it a try.”
Shrugging, she sets off—“Twenty, nineteen, eighteen…”—not quite smoothly, but with what seems like remarkable agility for a woman of 98.
For the fourth and final stroll, Dr. Beauchet again asks her to walk at her regular speed, this time while reciting the names of animals.
Ms. Deland can’t help but smile in surprise. “Oh, come on, animals?” she asks. “What kind of animals?”
“Whatever you like,” Dr. Beauchet replies.
“How about birds?”
“Birds are fine. Just go ahead.”
Chuckling to herself, she does—“Robin, sparrow, eagle…”—and, in the process, unwittingly reveals more about her physical and cognitive abilities than she might imagine.
As Dr. Beauchet’s patient, Ms. Deland is fortunate to have access to the JGH Mobility Clinic, the only facility in Quebec that, since 2016, has been using this type of carpet for clinical evaluations, rather than exclusively for research.
Every time she takes a step, numerous sensors in the carpet—officially known as a ProtoKinetics Zeno Walkway—capture a wealth of information about how she plants her feet, which way she leans, whether she hesitates in taking the next step, and much more.
This digital data is transmitted by a cable to a nearby laptop, where special software displays the results in graphic and numeric form. Using this information, Dr. Beauchet, a geriatrician/neurologist/internist who is Director of the Mobility Clinic, can gain a clearer understanding of Ms. Deland’s overall physical functionality, her level of frailty, and any instability in her gait that might put her at risk for falling.
Equally significant, the specifics of her gait can even help Dr. Beauchet to determine whether any cognitive deterioration has taken place. In normal circumstances, he explains, walking is an automatic and rhythmic task that the brain can handle easily, even if an individual is preoccupied with something else, such as counting backwards or reciting the names of animals.
However, if cognitive impairment has occurred, a person may find it hard to walk normally while performing a secondary task that requires extra concentration. This difficulty shows up in the hesitations or misplaced footsteps that are recorded while the patient walks along the carpet.
The great advantage of the carpet is that it generates data that can be assessed and compared objectively, says Dr. Beauchet, who is Director of the RUIS McGill Centre of Excellence in Aging and Chronic Disease, a Professor at McGill University, and holder of McGill’s Dr. Joseph Kaufmann Chair in Geriatric Medicine. “If you ask several professionals to analyze the same patient, the answers may vary. This way, you have an objective way of performing the measurement.”
Like the carpet, the Mobility Clinic has been in operation at the JGH for about a year and is geared largely toward patients who have problems with mobility or balance, as well as those who are at risk for falling. Patients are referred in various ways, including by a family doctor, geriatrician or orthopedist, or by a doctor who has examined the patient in the Emergency Department as a result of a fall.
Dr. Beauchet notes that the carpet is just one of several tools that can help doctors—as well as other professionals on the inter-disciplinary team—to formulate the correct diagnosis and develop an appropriate course of treatment or care.
For example, data from the carpet, when combined with other observations, might enable a physician to understand that the patient’s balance is not what it should be. Consequently, a plan can be drawn up to improve the patient’s posture, thereby reducing the risk of falling.
“We also follow up to make sure the intervention is the right one,” Dr. Beauchet adds, “and we can change the intervention, based on the evolution of the gait disorder. This was not possible before a device like this carpet came into use.”