Nowadays, mobility means freedom, flexibility
and autonomy for all citizens, including older persons.
On the other side, aging is characterized by functional changes
in the sensory, neurological and musculoskeletal systems, affecting
motor tasks including gait and postural balance. Gait and balance
disturbances in elderly are the main risk factor for falling. Every
third person aged over 65 years is at the risk of falling or has
had an experience of falling. These falls cause physical
injury, emotional trauma and mobility avoidance. The most effective
way to counteract falls is to improve movement capabilities. This
may be achieved by training and rehabilitation programs focused
to enhance or recover the performance of real life activities through
the application of problem solving in normal situations (walking
on rough grounds, standing up, climbing stairs, overcoming obstacles).
A problem solving approach means to address motor learning processes
by directly influencing motor behaviour, i.e. the way an action
is designed and not muscular force or joint mobility only.
SMILING project implements such an approach
through an innovative ICT system, able to change tasks to the user within
his/her usual living environment.
Existing training and rehabilitation methods are based on movement
repetition and correction or balance training for standing and not
on problem solving for active walking. By applying conventional
training interventions to improve walking in elderly at risk of
falling some important factors such as the dynamics of the walking
motor behaviour and the motor learning processes in the elderly
The SMILING project plans to diminish age related
impairments through the interference of diminished neural plasticity
that limits walking ability and by continuing these functional improvements
into real life situations. Research undertaken in USA and Israel
has shown strong indications that the vicious circle of muscle weakness
and time delay in the Central Nervous System (CNS) that causes gait
and balance impairment could be weakened by applying unexpected
external motion perturbations. These perturbations can loosen stiff
walking patterns and hence introduce more flexibility into the motor
control system to give improved stability.
Elderly people at risk of falling can be considered
to be suffering from an involuntary and stereotyped motor behaviour
that restricts their participation in society. One method to overcome
such a situation is to break the stereotyped motion schema and activate
a new learning process to better approach real life tasks in a better
way. To pursue such a target, the SMILING project exploits
chaos theory and dynamic systems theory with applications in the
training of the ageing populations.
The SMILING solution, a wearable non-invasive
computer-controlled system, performs chaotic perturbations to
the lower extremities during active walking through small alterations
of the height and slope of weight-bearing surfaces.
SMILING develops innovative training
programs for elderly people, to be accomplished at home, in fitness
clubs and health centres, with the aims of improving walking and
balance, and to prevent and counteract falling.
The overall objectives are:
1. To develop and construct an advanced prototype of a wearable
non-invasive computerized miniature system for mechanical chaotic
perturbations of gait pattern in order to counteract and prevent
tendencies to fall.
Two prototypes of wearable motorised
shoes were developed to test their acceptability by elderly and
their reliability in training as you can see in the pictures on the left.
One was selected for a wider clinical testing on groups of elderly in four countries.
The system is composed by a motorised pair of shoes driven by a devoted electronics;
a wireless module to allow gait phases detection and complete walking
analysis investigation; a User Control Unit to allow the subject
undergoing training to manage his/her own training program.
2. To develop stimulation algorithms fitted to suit individual user's
This part of the project is currently ongoing.
A set of training tasks have ben identified and are proposed to elderly people
for their validation. The aim is to identify which training paradigms
may benefit from the SMILING system concept.
3. To implement a system for training to be spread in rehabilitation,
health care and fitness centres for a reorganization of the rehabilitation
process in ageing. Also if dissemination and exploitation
actions are already approaching stakeholders in the rehabilitation
field, this will be accomplished in the very late part of the project,
when preliminary results from the SMILING system validation will allow
to prove its acceptability and usability.