“In 2008, there were some 84 million elderly people in the European Union. A third of them face the risk of falling. That’s around 28 million people. Falls are a huge, dangerous risk for millions of people.”
Lucilla Ballone Burini recently fell and broke her arm:
“I was walking on a wet pavement. I was wearing rubber shoes. And I slipped. My glasses fell off. I fell on my shoulder and then my head hit the pavement. Right after, I felt slightly stunned.”
“People helped me get up,” she says. “I came home. I was in quite a lot of pain. Two nights later, I had be taken to the hospital. My back was completely black. My upper-arm was broken.”
Liliana Barcaglioni also fell and hurt herself:
“One evening, I fell on the stairs, it was a bad fall. I went home, I was bleeding. It was a very difficult time for me, made worse by the fact that I live alone,” she says.
For Fiorella Marcellini, the new shoes developed under the Smile project have more than just a functional purpose:
“At the end of the day, what does mobility mean for elderly people, what does it mean to be able to go for a walk, to go out?,” she asks. “Of course, it’s a physical function, but it is also a way to keep in touch with society, it is a vital way of being a part of society.”
“Elderly people who have suffered a fall don’t just lose their balance at a given moment,” she says. “There’s often a cause or an aftermath. Many of them also lose the ability to walk safely, they are no longer able to link motor, physical movements with impulses coming from the brain. So they need training. And the best way to do this is to provide them with an unstable environment”.
And that is precisely the aim of this strange pair of shoes recently developed by European researchers.
In Ancona, one of the capitals of Italian shoe fashion, volunteers have been recruited to test them.
They all are over the age of 65 and have all suffered a bad fall.
The first step is to customise the shoes to each user.
A physiotherapist monitors the whole process.
“This remote control gives us the necessary instructions,” says physiotherapist Carla Strubbia. “Information concerning each patient, including shoe size, height and weight, is sent from the computer to this remote control. The software system then elaborates a customised training session adapted to each patient’s physical specificities and needs.”
Studs on the soles of the shoes randomly change angles to destabilise the wearer, stimulating his brain in order for force him to keep his balance.
“So the shoes change angles all the time. We also stimulate the users’ brains with other tricks. Wearers must listen to various instructions, follow a path along coloured lines on the floor. And they also have to carry out what we call “a dual task”, an additional activity to walking, in this case, this woman is juggling with a ball,” says Carla Strubbia.
“All our patients have fallen at least once. They need to regain trust. With this training we try to teach them to get used to obstacles they might find while walking outside in the street. The training definetly helps their bodies relearn motor strategies that they can then use in their daily lives. They learn how to perceive their own bodies in a given space. And by doing so, they improve their quality of life,” she adds.
It took four years to build and assemble the 300 components that make up each shoe.
It was at the University of Bologna that parts of the shoe’s electronic system were developped.
The technical challenges were huge.
Elisabetta Farella is an Electronics Engineer at the University of Bologna:
“There were very strict technical requirements, for instance very narrow electronic circuits. We also had to sort out crucial safety issues. The electricity supply system has to be able to manage shortcircuits and low voltage episodes by itself, to avoid any risk of harming users.”
Validation tests have been carried out in four different cities, including Kosice in Slovakia.
Elderly people with a history of gait and balance disorders visit the city’s Geriatric Centre to test the shoes in a real-life environment.
Terézia Fridrichova is a volunteer in the Smile project:
“Lately, I have suffered from gait and balance disorders. Not long ago, I was walking along the street one morning, and I just wasn’t able to keep my balance. I went to the doctor’s. There was a problem in my inner ear. I had to take drugs for nearly two months”.
Biomedical engineers and physiotherapists have gathered useful information on how the brain can be challenged to re-learn motor strategies.
Alena Galajdová is a biomedical engineer at the Technical University of Kosice:
“Balance problems are partially caused by muscle weakness and disorders within the nervous system. We think that some of these problems can be resolved by unexpectedly disrupting the patient’s motion. That’s the goal of this shoe. To disrupt motion in order to weaken balance problems.”
Physiotherapist Nadezda Harcarova works at the Geriatric Center in Kosice:
“In this geriatric center I work with senior citizens suffering from vertigo, and who have problems keeping their balance. Any neuro-rehabilitation tool that can provide them with more autonomy and greater independence in their daily lives is very welcome,” he says.
Back in Italy, computer scientists at the University of Bologna are already looking to the future – they have some challenging ideas.
Computer scientist Carlo Tacconi:
“The remote control that manages pattern download and orders could be a smart phone. The whole mechanical structure of existing shoes could be much more simple, and inserted into an ordinary shoe. So users, not only elderly people, but also younger people if they need it, could use the whole system to train at home.”
There is indeed wide room for improvement, even according to the researchers working on the project. Only time will tell what path these mechatronic shoes will follow in the future.