Usability test for a cane-combined weight support feedback device

Abstract

BACKGROUND:

Traditional canes have no special functions besides weight support, and their long-term use may cause secondary damage to the musculoskeletal system and gait deviation.

OBJECTIVE:

This study aimed to investigate the usability of the cane-combined weight support feedback device (CWSFD) to identify areas requiring improvement and the current level of satisfaction.

METHODS:

As a collet-type device, the CWSFD has a structure allowing attachment and detachment at the lower end of a traditional mono cane. To assess the level of satisfaction and areas of improvement regarding the novel CWSFD, a usability test was conducted on 10 physical therapists with $\geqslant$ 20 years of clinical experience. The usability test comprised a satisfaction survey questionnaire to determine the level of satisfaction, and an in-depth interview to identify the points of improvement.

RESULTS:

The usability test demonstrated a moderate or higher level of satisfaction in all tested items, and the in-depth interview revealed that the device should have a lower weight with a greater diversity of feedback.

CONCLUSIONS:

We anticipate that by implementing the respective improvements, a novel device will be developed in the future; for its commercialization, studies to verify the clinical effectiveness are warranted.

Keywords

Cane gait satisfaction usability test weight support

1. Introduction

Gait is a fundamental factor for the evaluation of daily activities and quality of life. Older adults experience reduced muscle strength, balance, gait, and physiological activities, with consequent lower adaptation to unforeseen situations and increased risk of falls [1]. Fall accidents inflict physical damage and affect emotional aspects of an individual; for example, older adults with a history of falling have lower quality of life due to decreased mobility and maneuverability caused by the fear of falling, loss of confidence, and limited gait [2].

The fear of falling has led to increased use of gait-assistive devices among older adults [1]. For those with difficulties in independent gait or in the early stage of gait training, various gait-assistive devices are prescribed for positive effects during rehabilitation. Gait-assistive devices can effectively increase the base of support (BOS), decrease the weight load on the lower limbs, provide additional sensory data, and assist with acceleration during gait [3]. Canes and walkers are the most well-known gait-assistive devices. Cane use can increase the BOS and enhance stability via the redistribution of weight and improve balance by providing tactile information [4]. The use of a walker may improve mobility through increased BOS, as well as stability via weight support; however, walkers require a greater level of attention than canes and pose challenges in movements on stairs and in narrow spaces [4]. Thus, canes are preferred in cases that do not necessitate weight support using both hands [3].

Canes are categorized into mono canes and quadripod canes, and a circular handle may be added for weight distribution [5]. Typically, canes are made of either wood or aluminum due to their low cost and low weight for balance and weight support. Notably, quadripod canes offer a higher level of support for a more effective prevention of fall accidents [6]. However, previous studies report that the use of canes may lead to excessive load on the musculoskeletal system and biomechanical disadvantages, including increased risk of falls and pain in the wrist and shoulder joints, as well as reduced accuracy of motor and sensory functions, postural stability, and weight shifting ability [5]. If a cane is not given an adequate level of weight support, the effect of gait training may be reduced, asymmetrical gait patterns may develop, and the risk of fall accidents may increase. Besides suitable training is lacking in most cases; thus, the prescription and use of a cane require caution [4]. Therefore, selection of a suitable gait-assistive device, improvement of the device to increase mobility and prevent side effects, and expert-led training are important [4]. Consequently, canes have undergone continuous improvement. These improvements focus on convenience (including enhanced design for conventional devices [7]); however, functional improvements, such as an assistive role for fall prevention by providing vibration according to the cane’s inclination have been achieved [8].

Various efforts have been made to enable physical therapists to quantitatively assess patients undergoing rehabilitation of cane-assisted gait and improve the method by which patients can self-rate the level of weight support [9, 10]. Mercado et al. [9] developed a quad cane with an audio-feedback monitoring system for weight support reporting positive effects in 60% of the 30 participants. Another study [10] reported that that the user’s dependence on the cane can be measured using a pressure sensor mounted on the cane. Nonetheless, these improved products pose various challenges such as heavy weight, high cost, and difficult attachment or detachment on mono canes. Therefore, we developed a cane-combined weight support feedback device (CWSFD) to improve gait symmetry and the effects of gait training by preventing and enhancing cane-related gait deviation and secondary damage to the musculoskeletal system, for which weight support can be quantitatively set in realtime using a conventional cane. This study aimed to investigate the current level of satisfaction with CWSFDs and areas requiring improvement in the future using a usability test among physical therapists. The hypothesis of this study is that required improvements for CWSFD’s can be discovered through this usability evaluation targeting physical therapists.

2. Methods

2.1 Participants

To assess the level of satisfaction and points of improvement regarding the novel CWSFD, a usability test was conducted on 10 physical therapists with $\geqslant$ 20 years of clinical experience. All participants were fully informed regarding the characteristics and purpose of the usability test; with understanding, the participants consented to participation. Table 1 presents the general characteristics of the participants.

Table 1
Characteristics of the participants ( $N=$ 10)

Category	Mean (SD) or frequency
Sex (male/female/total)	10/0/10
Education level (bachelor’s degree/master’s degree/Doctor’s degree)	8/1/1
Height (cm)	174.30 $\pm$ 4.52
Weight (kg)	74.60 $\pm$ 6.22
Age (years)	46.50 $\pm$ 4.79
Body mass index (kg/m²)	24.53 $\pm$ 1.49
Clinical experience (years)	20.10 $\pm$ 4.56

SD: standard deviation.

2.2 Cane-combined weight support feedback device (CWSFD)

The CWSFD was developed for mobility assistance and gait training in older adults and patients with poststroke hemiplegia difficulties in independent gait. As a collet-type device, the CWSFD has a structure allowing attachment and detachment at the lower end of a traditional mono cane (Fig. 1). A pressor sensor measures the level of weight support for the cane in kilograms, and the information is transmitted to a smartphone app for display; the smartphone app allows control of the weight support and gait training protocol. The CWSFD measures the average weight support (cane dependence) of the user in cane-assisted gait, and based on the measurement, a threshold value can be set. If the level of weight support exceeds the set threshold during gait, the smartphone app sends negative feedback to the user, who may thus lower cane dependence (the extent to which weight is supported by the cane).

Figure 1.

Cane-combined weight support feedback device.

2.3 Procedures

Three assistants participated for usability test. Prior to the usability test, the participants were trained on how to use CWSFD and the usability test procedure. The assistant confirmed whether the participants knew how to use CWSFD. Afterwards, the participants performed the designated usability test using CWSFD according to the trained procedures. The usability test comprised a questionnaire to determine the level of satisfaction and an in-depth interview to identify the points of improvement.

For the satisfaction survey, participants combined the CWSFD with a typical one-leg cane and connected the device to the app on a table PC. Afterward, they walked 10 steps using the CWSFD-attached cane, while the app automatically measured the average weight support on the cane for the user (cane dependence). Based on this measurement, the user freely adjusted cane dependence between 1% and 100%, and walked using the CWSFD for 20 min. Walking using the CWSFD was conducted on uphill and downhill indoor and outdoor courses. If the load on the cane exceeded the set level of cane dependence, a warning sound was released from the Bluetooth-connected tablet PC. After 20 min of using the device, the participants completed a satisfaction questionnaire (on a 5-point scale) comprising four categories (safety, maneuverability, function, and management) and 17 sub-categories (Table 2). On completion of the questionnaire, participants were interviewed in-depth by the research team for 15 min regarding what should be improved and the appropriate level of cost in the market. The one-on-one in-depth interview was conducted in a quiet, independent room, and the areas of improvement for the CWSFD were identified (Table 3).

2.4 Scientific background

Older individuals and people with disabilities use assistive devices to overcome physical or cognitive limitations and increase activity and participation [11]. Recently, assistive devices have been recognized as a part of the human body; as a result, the usability of assistive devices has become important [12]. According to International Standard Organization (ISO) 9241-11, usability is defined as “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use”, and effectiveness, efficiency, and satisfaction should be considered as factors to evaluate usability [13]. Effectiveness can be evaluated by whether the user achieves the task, efficiency can be evaluated by the resources required to accomplish the task, and satisfaction can be evaluated by the user’s subjective attitude and feelings about using the device [14]. Therefore, the usability of assistive devices can be defined as the user’s interaction with assistive devices to properly perform a task in a specific situation; the systematic observation, description, and analysis for usability can be defined as usability test [13].

Canes are the most widely sold assistive devices in South Korea; they are used to prevent falls while walking and assist gait training [15]. The development and usability test of canes for the visually impaired people and has been steadily progressing around the world [16, 17]; in contrast, research on the development and usability test of canes for walking assistance for the older adults and people with disabilities is insufficient. Routson et al. [18] developed a smart cane with vibrotactile biofeedback (including a piezoelectric quartz force line and vibration motor) to provide appropriate weight bearing in knee joint for knee osteoarthritis (OA), and the possibility of adjusting knee weight bearing was tested in 10 OA patients. In addition, Winston et al. [19] developed a Smart Cane system including a three-axis accelerometer, three single-axis gyroscopes, and two pressure sensors for correct cane use and fall prevention in older adults; however no usability test or clinical effectiveness analysis was conducted.

In South Korea, canes can be sold in the market if they pass a performance evaluation (Safety Standard, Annex 11 [sticks for elderly]) administered by the Korea Agency for Technology and Standards and receive certification [20]. In addition, the support center for senior friendly industry under the Korea health industry development institute provides usability test standard guidelines to minimize errors in the use of canes and ensure safe and effective performance [15]. The standard usability test sheet presented support center for senior friendly industry consists of three indicators (safety, operation and functionality, and convenience [satisfaction]) and 17 questions; all questions are evaluated on a five-point scale (1, highly dissatisfied; 2, dissatisfied; 3, moderate; 4, satisfied; and 5, highly satisfied). The safety indicator (seven questions) evaluates whether the cane is manufactured safely to prevent harm to the user. The operation and functionality indicator (seven questions) evaluates whether the cane can be used for the purpose it was manufactured. In addition, the convenience (satisfaction) indicator (three questions) evaluates satisfaction with cane use and completeness of the product. The usability test comprised the following three stages. First, the user sits on a chair and adjusts the height according to cane use. Second, the participant stands up from the chair and walks a 5 m forward (including a 1 m ramp and a 2-step stairs) using a cane. Third, the user sits on a chair and fills out a usability test sheet. Conclusions are reached using the average score for the usability test for each indicator. If the average of the scores in all three indicators is 4.0 points or higher, a suitable will be made, and if any one of the safety indicators is 4.0 points or lower, the overall result will be judged unsuitable.

2.5 Satisfaction survey questionnaire (usability test sheet)

In the present study, to perform a usability test on CWSFD, we used a modified usability test sheet, which is based on the standard usability test sheet provided by support center for senior friendly industry in South Korea. The modified usability test sheet consists of four areas (safety, maneuverability, function, and management) and 17 items (safety 5, maneuverability 5, function 4, and management 3). All items were measured on the following 5-point scale: 1, highly dissatisfied; 2, dissatisfied; 3, moderate; 4, satisfied; and 5, highly satisfied.

2.6 Data analyses

SPSS (version 27.0; IBM Corp., Armonk, NY, USA) was used to perform all statistical analyses. The general characteristics of the participants were presented using descriptive statistics and frequency analysis. Additionally, the results of the satisfaction survey were expressed as means and standard deviation.

Table 2
Results of the satisfaction survey ( $N=$ 10)

Area	Item	Questions	Point
Safety	Foot contact stability	Is there a risk of slipping upon foot contact on the ground?	3.04 $\pm$ 1.39
	Installation stability	Is there a degree of instability, such as shaking of the installed module?	3.84 $\pm$ 1.15
	Contact-related health hazards	Is there a risk of health hazard upon use?	4.50 $\pm$ 0.70
	Gait-related risks	Is there a risk factor during gait?	4.20 $\pm$ 0.42
	Combination stability	Is there a potential problematic factor in combining the cane module?	3.60 $\pm$ 1.26
Total average			3.88 $\pm$ 1.13
Maneuverability	Handiness	Is the basic manipulation easy?	3.99 $\pm$ 1.10
	Compatibility	Is it compatible with various cane types?	3.78 $\pm$ 1.08
	Learnability	Is the level of difficulty appropriate in the usability training?	4.13 $\pm$ 0.84
	Software (Application)	Is the app intuitive and appropriately structured?	4.11 $\pm$ 0.30
		Are the app and module adequately connected without intermittent disconnection?	4.22 $\pm$ 0.40
Total average			4.06 $\pm$ 0.50
Function	Reactivity	Are the feedback results adequate in various foot contact angles?	3.92 $\pm$ 0.29
	Accuracy	Does the module accurately detect the set weight support?	4.20 $\pm$ 0.40
	Audibility	Is the volume of auditory feedback on weight support appropriate for hearing?	3.71 $\pm$ 0.46
	Gait improvement	Does the weight-support feedback adequately assist with the improvement of gait?	4.11 $\pm$ 0.30
Total average			3.99 $\pm$ 0.17
Management	Weight	Is the weight of the module appropriate?	2.32 $\pm$ 0.92
	Washability	Is the washing of the device convenient?	4.02 $\pm$ 0.90
	Chargeability	Is the battery charging of the module convenient?	4.13 $\pm$ 0.55
Total average			3.46 $\pm$ 0.59

Table 3

Main results of the in-depth interview on the four satisfaction survey areas

Area	Points of Improvement
Safety	The contact on the ground is adequate without risk of slip. The module is stably connected with the mono cane. There is no safety problem.
Maneuverability	The Bluetooth connection distance between the smartphone and the cane should be increased.
Function	The feedback type should be diversified (including more varied signals, such as vibration or LED, in addition to auditory feedback).
	The weight support measurement is only accurate in the case of vertical contact with the cane on the ground. The measurement should be improved to ensure accurate weight support in cases other than vertical contact.
Management	The metallic material is too heavy for use by older adults or patients with poststroke hemiplegia. The weight should be reduced.

3. Results

3.1 Results of the satisfaction survey

Table 2 shows the results of the satisfaction survey. The safety score (comprising five items and five respective questions) was 3.88 on average and ranged from 3.04 (foot contact stability) to 4.50 (contact-related health hazards), indicating a moderate or higher level of satisfaction for the stability of the CWSFD. The maneuverability score (comprising four items and five respective questions) was 4.06 on average and ranged from 3.99 (handiness) to 4.22 (software), indicating a high level of satisfaction for the operation of the CWSFD. The function score (comprising four items and four respective questions) was 3.99 on average and ranged from 3.71 (audibility) to 4.20 (accuracy), indicating a moderate or higher level of satisfaction for the CWSFD function. The management score (comprising three items and three respective questions) was 3.46 on average and ranged from 2.32 (weight) to 4.13 (chargeability), indicating a moderate level of satisfaction. The score for weight indicated dissatisfaction (2.32), which should be noted.

3.2 Results of the in-depth interview

Table 3 shows the main results of the in-depth interview regarding the four satisfaction survey areas. In the safety category, participants did not suggest any points of improvement. In the maneuverability category, an increase in the Bluetooth range between the smart phone and CWSFD was suggested. In the function category, a need for a greater diversity of feedback signals such as vibrational or visual (LED) signals, and auditory signal was suggested. In the management category, it was suggested that the weight should be reduced using a low-weight material such as plastic.

4. Discussion

A gait-assistive device is used to enhance independent mobility and minimize fall accidents and injuries to prevent dysfunction and reduce treatment costs [21]. Canes are used for mobility and rehabilitation training in persons with disabilities, and older adults who experience difficulties in gait and balance control due to reduced muscle strength, lower limb surgery, or nervous system injuries [6]. Nevertheless, canes have no special functions besides weight support, and their long-term use may cause secondary damage to the musculoskeletal system, as well as gait deviation from one-sided use [10]. If an inappropriate gait pattern persists, the activation of lower limb extensor muscles may be suppressed; this has a negative effect on independent gait and muscle activities due to weight load on the lower limbs [22].

Previous studies have adequately explained the need for a gait-assistive device and the related side effects in stroke patients [23, 24, 25]. Independent walking requires proper body alignment and appropriate weight distribution and weight transfer to both lower extremities. However, stroke patients have limited walking ability due to unbalanced body alignment, asymmetric weight distribution, and weight shifting [23]. Restoration of the motor function of the paralyzed lower extremities is essential to restoring the independent walking ability of stroke patients [24]. Through this, it should be possible to induce appropriate weight support and weight transfer to the non-paretic side [25].

Choi et al. [26] compared lower limb muscle activity according to the type of cane-assisted gait in patients with stroke. This study reported that the level of weight support varied according to cane and gait types and demonstrated that the increased lower limb muscle activity associated with gradually reduced cane dependence may be effective for gait recovery. Guillebastre et al. [23] conducted a study on patients with stroke and the general population and reported a $<$ 5% probability that a patient without $\geqslant$ 40% weight load on the paretic leg could walk without a cane. This result implied that a crucial factor in improving independent mobility is to increase the weight support in the paretic leg. In addition, Bastian [27] highlighted the importance of motor adaptation and learning in rehabilitation, for which motor adaptation was defined as the correction of motion through continuous feedback on errors [28], and learning was defined as the acquisition of a new motion through repeated motor adaptation [29].

In the present study, the CWSFD was developed based on biomechanics involving motor adaptation and learning. The CWSFD is designed to be attachable and detachable at the bottom of the traditional mono cane to increase convenience, and maneuverability is improved by provision of real-time feedback of the user’s cane dependence through a smartphone application wirelessly connected to the CWSFD. The result of this usability test targeting physical therapist showed the total satisfaction was 3.46 points out of 5 points. The satisfaction results for each item were 3.88 for safety, 4.06 for maneuverability, 3.99 for function, and 3.46 for management. Of the usability tests for each item, satisfaction with maneuverability was observed to be the highest at 4.06 points, and this is thought to have been influenced by technical improvements (cane dependence feedback, attachment and detachment function) absent in existing traditional mono cane. Meanwhile, satisfaction with the management item was observed to be the lowest at 3.46 points, and in particular, satisfaction with the weight of the CWSFD received the lowest score of 2.32 points among all questions. The CWSFD (515 g) is heavier than a traditional mono cane (350 g), which may limit its use by older individuals or people with disabilities. Therefore, there is need for advanced development to reduce weight of the CWSFD for commercial adoption. According to the standard usability test sheet provided by support center for senior friendly industry in South Korea [15], all questions in safety must show a satisfaction rating of 4.0 or higher for suitability. However, the result of this usability test show that the safety area was 3.60 points, which is 0.4 points lower than the standard usability test sheet’s safety area standard score. Thus, we believed that future improvements will be needed to prevent slipping of the CWSFD and how to attach and detach from the traditional mono cane.

The physical therapist who walked for 20 min using the CWSFD participated a one-on-one in-depth interview after completing the usability test. Physiotherapists with 20 years of clinical experience who participated in this study stated that the CWSFD can be appropriately used in clinical practice to reduce cane dependence. However, the level of dissatisfaction regarding the heavy weight of the metallic CWSFD (aluminum alloy) was high; thus, the weight should be reduced to allow use by older adults or patients with poststroke hemiplegia. In addition, there is a need for a greater diversity of feedback signals, such as vibrational or visual (LED) signals, in addition to auditory signals. Further studies should resolve these limitations and verify the clinical effectiveness of the CWSFD in patients with poststroke hemiplegia.

This study had some limitations. Only male physical therapists participated in this study, which may have influenced the survey of satisfaction and improvements in each area. In addition, if a usability test comparing the existing traditional mono cane and CWSFD had been conducted, a more diverse and accurate investigation may have been performed. Following advanced development to improve the shortcomings revealed in this usability test, further usability test that allows for comparative analysis with the existing traditional mono cane or CWSFD before improvement should be conducted.

5. Conclusion

This study investigated the usability of CWSFDs to identify areas requiring improvement and the current level of satisfaction. The usability test demonstrated a moderate or higher level of satisfaction in all tested items, whereas the in-depth interview revealed that the device should be lower in weight with a greater diversity of feedback. We anticipate that by implementing the respective improvements, a novel device will be developed in the future; for its commercialization, studies to verify its clinical effectiveness are warranted.

Footnotes

Conflict of interest

Ki Hun Cho has an applied patent for the cane-combined weight support feedback device. The remaining authors have no conflicts of interest to declare.

Funding

Following are results of a study on the “Leaders in INdustry-university Cooperation 3.0” Project, supported by the Ministry of Education and National Research Foundation of Korea. In addition, this work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (No. 2018R1C1B5084411 and No. 2022R1F1A1068815).

References

Kim

Namkoong

Roh

. Effect of lower extremity muscle activity to the use of a variety of walking aids. Journal of the Korea Academia-Industrial cooperation Society. 2015: 741-744.

Lee

Ahn

Kim

Jeong

Kim

, et al. The effects of falling and fear of falling on daily activity levels in the elderly residing in Korean rural community. J Korean Geriatr Soc. 2009; 13(2): 79-88. doi: 10.4235/jkgs.2009.13.2.79.

Hwang

Cho

. Usability Test for Motion Tracking Gait Assistive Walker. J Korean Phys Ther Sci. 2023; 30(4): 1-8. doi: 10.26862/jkpts.2023.12.30.4.1.

Bradley

Hernandez

. Geriatric assistive devices. Am Fam Physician. 2011; 84(4): 405-411.

Son

S-M

Choi

Y-W

Kim

C-S

. articletitleEffect of motor functions of ipsilateral upper limb induced by long-term cane usage in chronic stroke patients. J Korean Soc Phys Ther. 2012; 24(2): 151-156.

Bateni

Maki

. Assistive devices for balance and mobility: Benefits, demands, and adverse consequences. Arch Phys Med Rehabil. 2005; 86(1): 134-145.

Yoon

. A study on the development of smart stick design in preparation for falling accidents for older adults. 2021; Pukyoung National University.

Pyo

Yoon

. Design of active fall prevention haptic cane for providing ground condition detection and gait stability. Journal of the Human Computer Interaction Society of Korea. 2014: 25-28.

Mercado

Chu

Imperial

Monje

Pabustan

Silverio

. Smart cane: Instrumentation of a quad cane with audio-feedback monitoring system for partial weight-bearing support. In: 2014 IEEE International Symposium on Bioelectronics and Bioinformatics (IEEE ISBB 2014). Chung Li, Taiwan; 2014. pp. 1-4.

10.

Kang

Cho

. Changes in lower limb muscle activation and gait function according to cane dependence in chronic stroke patients. Technol Health Care. 2021; 29: 133-41.

11.

Parant

Schiano-Lomoriello

Marchan

. How would I live with a disability? Expectations of bio-psychosocial consequences and assistive technology use. Disabil Rehabil Assist Technol. 2017; 12(7): 681-685. doi: 10.1080/17483107.2016.1218555.

12.

Lee

Kim

Jang

. Systematic Review of the Usability Testing Study on Assistive Technology Devices in Korea. J Spec Educ Rehabil Sci. 2019; 58(4): 279-298.

13.

ISO. ISO 9241-11:018 Ergonomics of human-system interaction – Part 11: Usability: Definitions and concepts [cited 2018 Nov 10]. Available from: https//www.iso.org/obp/ui/#iso:std:iso:9241:-11:ed-2:v1:en.

14.

Bevan

. What is the difference between the purpose of usability and user experience evaluation methods. In Proceedings of the Workshop UXEM (Vol. 9, pp. 1-4).

15.

The support center for senior friendly industry under the Korea health industry development institute [homepage on the Internet]. Seoul; 2022 [updated 2022 Dec; cited 2024 June 06]. Available from: https//www.khidi.or.kr/board?menuId=MENU00310&siteId=SITE00003.

16.

Chaudary

Pohjolainen

Aziz

Arhippainen

Pulli

. Teleguidance-based remote navigation assistance for visually impaired and blind people-usability and user experience. Virtual Real. 2023; 27(1): 141-158. doi: 10.1007/s10055-021-00536-z.

17.

Khan

Khusro

Ullah

. Technology-assisted white cane: evaluation and future directions. Peer J. 2018; 6: e6058. doi: 10.7717/peerj.6058.

18.

Mai

Xie

Zeng

Qiao

, et al. Laser Sensing and Vision Sensing Smart Blind Cane: A Review. Sensors. 2023; 23(2): 869. doi: 10.3390/s23020869.

19.

Jordan

Stathopoulos

Batalin

Kaiser

, et al. The SmartCane system: an assistive device for geriatrics. In 3rd International ICST Conference on Body Area Networks. 2020. doi: 10.4108/ICST.BODYNETS2008.2944.

20.

Korea Agency for Technology and Standards [homepage on the Internet]. Chungcheongbuk-do; 2024 [updated 2018 June 28; cited 2024 June 06]. Available from: https//www.kats.go.kr/content.do?cmsid=527&searchField=title&searchValue=%EC%A7%80%ED%8C%A1%EC%9D%B4&y=0&x=0&mode=view&page=1&cid=19176.

21.

Arefin

Habib

Arefin

. A comparison of mobility assistive devices for elderly and patients with lower limb injury: Narrative Review. Int J Aging Heal Mov. 2020; 2(1): 13-17. doi: 10.6084/m9.figshare.12318608.v1.

22.

Park

Cho

. Immediate effect of weight load on lower limb muscle activity and gait ability in patients with incomplete spinal cord injury during walker gait training. J Spinal Cord Med. 2023; 46(5): 818-824. doi: 10.1080/10790268.2022.2088502.

23.

Guillebastre

Rougier

Sibille

Chrispin

Detante

Pérennou

. When might a cane be necessary for walking following a stroke? Neurorehabil Neural Repair. 2012; 26(2): 173-177. doi: 10.1177/1545968311412786.

24.

Rougier

Genthon

. Dynamical assessment of weight-bearing asymmetry during upright quiet stance in humans. Gait Posture. 2009; 29(3): 437-443. doi: 10.1016/j.gaitpost.2008.11.001.

25.

Lee

I-S

Park

K-E

Hong

H-J

Sung

K-K

Lee

S-K

. The change of lateral shift of center of pressure according to the gait improvement in post-stroke hemiplegic patients. J Int Korean Med. 2014; 35(4): 448-454.

26.

Choi

Yang

Jung

Kim

Cho

. Changes in lower limb muscle activation and degree of weight support according to types of cane-supported gait in hemiparetic stroke patients. Biomed Res Int. 2020; 2020: 9127610. doi: 10.1155/2020/9127610.

27.

Bastian

. Understanding sensorimotor adaptation and learning for rehabilitation. Curr Opin Neurol. 2008; 21(6): 628-633. doi: 10.1097/WCO.0b013e328315a293.

28.

Martin

Keating

Goodkin