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stepWise - Skill Building One Step At A Time

Developing the skills needed to negotiate obstacles while walking may prevent future falls, so let's create opportunities to practice!

Photo of Bettina Fliegel

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Who is your idea designed for and how does it enable older adults to live their best possible life by preventing falls?

This idea is to create accessible walking paths, with simulated obstacles painted on the surface, so that older adults can safely practice functional walking and balance skills. Our goal is to decrease fall risk by maintaining and improving mobility and balance as well as engaging cognitive aspects important for safe walking. Fear of falling may limit one's motivation to move. The intent is as skills and confidence build seniors will walk more, enabling them to live independent active lives.

CONTENTS

The Idea - stepWise                                                                                           

Idea Development During the Challenge

   Prototype I

   Adding Rest and Exercise Stops to stepWise

   Target User Research

   OpenIDEO NYC Chapter Meet Up Feedback

   Prototype II

   Prototype II - Feedback, Insights, Learnings

Inspirations for stepWise 

                                                                                                                        STEPWISE

This idea came to mind after reading a research study in which older adults who had a history of falling trained on a treadmill while using virtual reality. They learned to negotiate obstacles on a virtual path.  Over the course of this six week training participants walked with more confidence and took longer steps.  They also had improved clearance of obstacles.  Six months post training participants had a decreased frequency of falls vs. the control group.  

Why not try a low tech approach in which any older adult can practice negotiating obstacles on a path in a safe manner?  The objective of the idea is to maintain or improve one's walking skills overtime.

Idea:  Create accessible walking paths that incorporate pretend obstacles painted on the path's surface so that older adult users may practice negotiating obstacles in safety.  

Goal:  To decrease fall risk by improving mobility, balance and cognitive skills allowing older adults to live safe, active lives.

Potential Sites For StepWise Paths   

I.  Outdoor Spaces

  1. Parks –  Paths near playgrounds might be a nice way to encourage families to spend time together in parks.  Children may enjoy walking the path as well.
  2. School Play Areas – To be used when school is not in session.  (Children might invent games on these paths during recess, in the same way they enjoy playing on city sidewalks hopping over cracks.) 
  3. Senior Centers - courtyards, on the roof.
  4. Senior Communities/Assisted Living - (As suggested by Mariah in a comment.)

II.  Indoor Spaces

  1. Shopping Malls – A site where people frequently walk for exercise particularly when weather is bad.
  2. Senior Centers - gym, social hall, hallways
  3. Senior Communities - social hall, hallways
  4. Private Homes
  5. Airports - (from user research) 


Surface Materials For StepWise Paths 

1)  Paths may be designed with different types of surfaces within one path, in addition to obstacles, to enhance this opportunity for balance training.  

For example, walking on concrete (which is very hard and sturdy) to foam to sand, going from stable to unstable surfaces, works on proprioception which is crucial to balance training.  [Kumi- in comments]  (Update 4/24/17)      

2)  In indoor spaces such as gyms or malls, consider using a projector to project a path with "obstacles".  In this way the idea might be implemented in spaces where an organization did not want to change the floor's surface.  (MJ - in comments.  Update 4/24/17)   

3)  Using a material such as foam, manufactured in pieces that interlock, might increase the versatility of these paths.  This opens the possibility for indoor/outdoor use within a community.  If pattern designs are created that are flexible to different configuration of pieces, paths might be constructed in sites of differing dimensions at different times.  This could accommodate flexible use in senior centers and senior living facilities. (Update 5/29/17)

Explore A Possible Intergenerational Experience 

  • Is there potential to create an intergenerational game using these paths?  
  • How might grandparents and grandchildren interact and play together?

____________________________________________________________

IDEA DEVELOPMENT During the challenge

PROTOTYPE I (Update 5/7/17)

What can I learn early from a quick test with users?  Are target users interested in this idea to promote health and prevent falls?

As a quick first test I used colored chalk to draw a path with shapes as "obstacles" on a dead end street. (Prototype Ia)

Instructions: Walk the path stepping over or going around obstacles, as you are able.

Two target users trying it out back and forth a few times.

Feedback

User 1:  Make it more spaced out.  It was hard when they were close together.   

User 2:  My problem is you need to do the whole thing looking down if they are flat.

Will there be places to rest?  Bathrooms to access?

Observations

The users generally went from obstacle to obstacle.  I had envisioned them walking straight on a path, stepping over whatever they might encounter.  

The experience prompted a playfulness in one user.

Prototype Ib - Based on feedback, test an experience in which "obstacles" are spaced further apart.  

Using a public walking/bike path at the end of the street a few "obstacles" were drawn on the concrete.  There are green divider lines on parts of this path.  

Instructions: Walk over obstacles and zig zag past green divider lines.

Target user testing the iteration.

Feedback  

"Much better."

Question to the User - Would it be a good idea to start easy and add more obstacles closer together at the end of a walk?  

No.  Place them close together intermittently along the way.

____________________________________________________________

ADD REST and EXERCISE STOPS  (Update 5/19/17)

After the first prototype a user asked:  

Will there be places to rest? 

Building on this, benches can be positioned along the way for rest and also exercise stops.  Signs will prompt users to do balance exercises using a chair or railing.  These simple exercises are something that a child might enjoy doing with an elder.  

[5/28/17 - Initially the idea was to use a bench for these "chair exercises." Monika mentions in a comment that for many users a bench will be too low.  She recommended a railing.  A railing was recommended by Mariah for indoor paths.  This has been added to the idea.]

Sample Balance Exercises Using A Chair

Sample signs.

____________________________________________________________

TARGET USER RESEARCH  (Update 5/23/17) 



Meeting with target users, ages 70 and 77, sharing the idea and gathering feedback.  Ideas for path design and use of different surface materials to enhance balance training were discussed.  

  • They preferred the idea to use different surface materials in different lanes side by side, rather than one path with a change in surface material along the way. 
  • They liked the idea to test different shapes and designs for visibility of path obstacles. 


 Obstacle Design - I like the 3D idea.  It might make you step over it higher.  It will help you prepare for real issues….  I am scared. 

A year ago I would have said who would do it?  Now I would say I would do it! Because I was thinking "Who is old? "  Now I fell a few times.  Now I am going to think a little bit more when I walk.

I love it!  I have done this.  I practice balance when I walk home.  I practice walking in a straight line..... It is hard.  I have a long wooden hallway floor at home and I practice there too.

Have options of different levels.  

Add "walk on a straight line" to the idea.

Share space with a playground.  

Have signs on these paths with ideas for goals.  "Lift your knee for 30 seconds.  Initially after surgery I could only do this for 5 seconds."

I think there will need to be some very clear guidelines regarding children on the path.

Next Step - Meet in a local park soon to test the idea.

(See Attachment 4 for full feedback from this session, Update 5/29/17.)                          

____________________________________________________________

OpenIDEO NYC Chapter: Two Refinement Phase Meet Ups  (Update 5/29) 

Feedback and Ideas - See Attachment 5

What role might local artists play in the design of these paths?

How might local culture come into play in the design of these paths?


                                                                                                                                                          ____________________________________________________________

PROTOTYPE II  (Update 5/28/17)

Determine What To Prototype  (Attachments 6, 7)

Prototype II Participants - Target users, ages 70 and 77.  Both participants have a history of falling in the past leading to injury.  Both currently live independent active lives in NYC.  A five year old grandchild of one target user also participated.

Prototype Materials - Paths for this prototype were created using paper, tape and glue.

Prototype IIa

First look at the prototype by users and a child.  An opportunity to observe.

IIb

Which obstacle type is preferred and why?

IIc  

Iteration - Spacing of obstacles.  One obstacle removed and another added. Has the experience changed?

IId  Two Exercise Stations 

Testing Exercise Instruction Signs and Exercise Stations

What is the user experience for adults and children?  

She asks me: Can I take these home?   

IIe 

Access to a rail.  Walking a line.  Moving laterally.


IIf  

Iteration - Adding footprints and arrows to guide users on the path.

IIg 

Trying a different surface material. 

How did kids interact with the prototype, with target users, and others?



While we continued user testing the grandchild went off and decorated her KIDS Mat on her own.


PROTOTYPE II - FEEDBACK, INSIGHTS, LEARNINGS

The prototyping was a productive, fun, collaborative effort.  Target users shared feedback and insights that will help to build the design.  

What did users value?  What excited them?

The general idea excites them.  They would like to see it implemented locally.  They were excited to think about possible sites with areas of shade.

Easy access to balance training outdoors excited them.

They value their independence.

They value attention to the health needs of older adults. 

They value and were excited by participation in the testing process.        

They value time spent with family and grandchildren. 

They value access to fitness instruction.

They value social connections. 

They value setting and achieving goals.     

(Full feedback on Prototype II - See attachment 3)

What NEEDS More INVESTIGATION?  What Needs Improvement?  

Communicating With Users 

Add a sign with general directions at the beginning of the course and use signs as prompts along the way.

Path Design

The cluster of obstacles was not well thought out.  Users were confused on what to do.  

Space obstacles so that users can walk at a steady pace. 

How might these paths fit into a shared space with children so that older adults feel safe but interaction is fostered?  

Obstacles 

Continue to test designs for best visibility.   

Intergenerational Engagement 

Get feedback from parents of small children in addition to target users.  

Continue to observe children interacting with the idea.  

Experience 

How might path design create space for free and imaginative play?  

Scale   

Interacting with the 5 year old grandchild, seeing her imagine and create a KIDS space using a mat that was the "right size" brings up the issue of scale.  How might design of these paths create spaces that feel right for kids and older adults?                                                                                                                                                                                                                                                                                                                                                                        _______________________________________________________

INSPIRATIONS for stepWise

1.  Medical Research 

A study reported in the medical journal Lancet which explored the use of virtual reality to train seniors to improve walking skills.

Study Week 1

Study Week 6 - Improvement


2.  Senior Playgrounds 

The idea was also inspired by a Research Post highlighting the development of senior playgrounds to improve fitness and reduce social isolation.  (Update 5/6/17)

Might stepWise paths become an addition to this movement?        

_______________________________________________________

THANK YOU

Thank you to the TEAM!  Your valuable feedback, insights and ideas contributed to the building of this Idea!

Thanks to everyone from the NYC OpenIDEO Chapter Meet Ups for your valuable feedback and ideas!

Thanks to the OpenIDEO community for checking out the idea and posting thoughts and feedback in the comments!

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

Create an obstacle pathway in a public space using colored chalk. Invite people to try it out to get feedback.

What skills, input, or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

Would anyone like to try this out with older adults in their communities?

Any ideas on creating an intergenerational game with these paths?

How long has your idea existed?

  • 0-3 months

This idea emerged from

  • An Individual

Tell us about your work experience:

I am a pediatrician and have practiced as a clinician, medical educator and administrator. I am interested in human centered design and social innovation. I mentor for the Design For America Club at NYU and have been a Community Mentor on OpenIDEO.

How would you describe this idea while in an elevator with someone?

Maintenance of walking skills can protect against falls. This idea is to create access and opportunity for older adults of different functional abilities to practice and improve walking skills in safety. The idea is a walking path featuring pretend obstacles, shapes painted flat on the ground, that seniors can practice on safely in order to allay fear of falling and build confidence over time.

How does your idea demonstrate our Criteria of Affordability?

The idea is to create paths that are freely accessible for any target user. This will be the case if paths are in public spaces. For paths in senior centers and senior living communities paths can be open to members of these communities. Funding may be via grants or sponsors - government, foundations, non profits, health care industry, public/private partnerships? Upkeep will be the responsibility of the organization managing the space where paths are built.

How does your idea demonstrate or plan to demonstrate scalability?

Create design templates for paths that can be replicated in any community. One suggestion was to work with artists in local communities to create designs which can then be shared to scale the idea.
Partnering with sponsors can help scale the idea. (See Affordability.)
A model to look at - Partnership between Humana Foundation and Kaboom to create intergenerational playgrounds in the US. Community members install the playgrounds together.
https://www.youtube.com/watch?v=o8N_7Zb0S5w&html5=1

How do you plan to measure the impact of your idea?

Start by measuring use and repeat use for one path. Interview users to assess impact on their lives.

Consult with a public health professional regarding studying impact of using these paths on preventing falls in the target population.

What are your immediate next steps after the challenge?

After recent prototyping the next steps are:
Iterate to create Prototype III. Consider path design pattern in consultation with a physical therapy professional. Share the new prototype with users of different functional abilities, in the community and in assisted living.

Share with target users, children and parents, for continued collaboration and feedback on ideas for an inter-generational experience.
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Attachments (7)

image.jpeg

Attachment 7 - Determine What To Prototype 2

image.jpeg

Attachment 6 - Determine What To Prototype I

OpenIDEO Chapter Feedback.pdf

Attachment 5 - OpenIDEO Chapter Meet Ups - Feedback and Ideas

Target User Research and Feedback_stepWise.pdf

Attachment 4 - Target User Research and Feedback

Attachment 2_stepWise _Fliegel_Post Update I. May 27_ .pdf

Attachment 2 - stepWise pdf Version 2_including updates to May 27, 2017

Attachment 1_stepWise_ Fliegel_ Fall Prevention Idea_ Fliegel_May 20_2017.pdf

Attachment 1 - stepWise pdf Version 1 _ including updates to May 20, 2017

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Photo of Mariah Burton Nelson
Team

Bettina Fliegel Hi Bettina, Sorry to be out of pocket for a while but thanks for including me on this team. Exciting to see how much progress you all have made!

BTW I spent Friday at a fabulous in-person workshop designing new product ideas related to the "How can we support caregivers for dementia?" challenge. We plan to post a team contribution soon. (Probably with the word GERI in the title.) Makes me appreciate this process - and the results - even more. Go OpenIdeo! :-)

Photo of Bettina Fliegel
Team

Hi Mariah. Thanks for getting in touch!
That is great feedback on the DC dementia workshop! I am a co organizer for the NYC OI Chapter, as of a few months, and we also worked with OI to host a workshop last week, also a great experience! I attended as a team facilitator. I will check out your team's idea! Our NYC team posted "Groceries For Care."

Photo of Mariah Burton Nelson
Team

Hi Bettina,

That's cool. Glad you hosted and facilitated. We posted two ideas, one called GERI; the other called Caregiving Is an Art. I'll go look for Groceries for Care.

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