Department of Neurology, Kiel University, Kiel, Germany.
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.
J Med Internet Res. 2023 Mar 30;25:e41082. doi: 10.2196/41082.
Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions.
This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases.
Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm.
In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use.
Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases.
German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998.
行走时转身是一种相关且常见的日常动作，它依赖于正确的自上而下的节段间协调性。在几种情况下（整体转身），这种协调性会降低，而改变的转身运动学与跌倒风险增加有关。使用智能手机与平衡和步态较差有关；然而，其对行走时转身的影响尚未得到研究。本研究探讨了不同年龄组和神经疾病患者在使用智能手机时的节段间转身协调性。
本研究旨在评估智能手机使用对不同年龄健康个体以及患有各种神经疾病个体转身行为的影响。
年轻（18-60 岁）和年长（>60 岁）健康个体以及患有帕金森病、多发性硬化症、亚急性中风（<4 周）或下腰痛的个体分别在单独使用智能手机（单任务[ST]）和同时执行 2 种不同认知任务（双任务[DT]）的情况下进行行走时转身。移动任务包括以自选速度在 5 米的走道上来回行走，从而包括 180°转身。认知任务包括简单反应时间测试（简单 DT[SDT]）和数字斯特鲁普测试（复杂 DT[CDT]）。使用运动捕捉系统和转身检测算法从头部、胸骨和骨盆中提取一般（转身持续时间和转身时的步数）、节段（峰值角速度）和节段间转身参数（节段间转身起始潜伏期和最大节段间角度）。
共纳入 121 名参与者。所有参与者，无论年龄和神经疾病如何，相对于头部，骨盆和胸骨的节段间转身起始潜伏期和最大节段间角度均减小，这表明在使用智能手机时出现整体转身行为。关于使用智能手机时从 ST 到转身的变化，帕金森病患者的峰值角速度减少最多，与下腰痛患者相比，这与头部明显不同（P<.01）。中风患者即使在没有使用智能手机的情况下也会出现整体转身。
在行走时转身过程中使用智能手机可能导致整体转身，从而增加所有年龄组和神经疾病组的跌倒风险。对于那些在使用智能手机时转身参数变化最明显且跌倒风险最高的组（例如帕金森病患者），这种行为可能尤其危险。此外，这里提出的实验方案可能有助于区分没有下腰痛和早期或前驱帕金森病的个体。对于亚急性中风患者，整体转身可能代表一种代偿策略，以克服新出现的移动缺陷。考虑到日常生活中无处不在的智能手机使用，本研究应刺激该领域跌倒风险和神经及骨科疾病的未来研究。
德国临床试验注册处 DRKS00022998；https://drks.de/search/en/trial/DRKS00022998。
