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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.
View more

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

155 comments

Join the conversation:

Comment
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.

Photo of Monika Mann
Team

Hi Bettina, I received notices that you have been editing the idea. Looks good. I noticed that one of your upcoming steps that you mentioned is meeting with a public health professional. I just wanted to let you know that as well as being the team's resident physical therapist I also have an MPH from Johns Hopkins and am an Associate Faculty member there. So I may be able to wear the public health hat too. All the best, Monika

Photo of Bettina Fliegel
Team

Thanks for reaching out Monika! I appreciate it. I haven't started next steps yet but am starting to think about it! Will be in touch.

Photo of Isaac Jumba
Team

Congratulations Bettina Fliegel !! This is so great

Photo of Chris Ashford
Team

Thrilled for you @Bettina Fliegel! Go get'em!

Photo of Bettina Fliegel
Team

Thank you OpenIDEO ! It is an honor to be chosen as a Top Idea!

Team  Congrats to all! It has been great to collaborate to build this idea together! I have enjoyed the conversations and have learned much!

Photo of Monika Mann
Team

Fantastic! Congratulations! I look forward to seeing this great idea move forward.

Photo of Bettina Fliegel
Team

Thanks Monika!

Photo of Kumi
Team

Congratulations Bettina! I hope you are proud of your hard work. I really love this idea, I hope we can see it come alive some day!

Photo of Bettina Fliegel
Team

Thank you!
It has been great collaborating with you during this process. Your expertise has been extremely helpful in developing the idea thus far, as you shared ideas and feedback. We will see how this might continue to develop!

Photo of Lee-Jung Kim
Team

Yeh!!!! Congratulations Bettina!!! You are... Always thinking... Always doing.... Always creating.... Such a great win!!!

Photo of Bettina Fliegel
Team

Thanks so much Lee!

Photo of Nita Lakhani
Team

Congrats, Bettina! What an awesome idea and lots of work put in to prototyping and iterating!

Photo of Bettina Fliegel
Team

Thank you!

Photo of Freddy Shimabukuro
Team

Congratulations Bettina and team!! You all did a great job here.

Glad I've met you in person, I'm sorry we didn't have enough time.

Photo of Bettina Fliegel
Team

Thank you Freddy! Yes, it was great to say hi when you stopped by at the NYC Chapter meet up. What a surprise that was!

Photo of Karine Sarkissian
Team

Congratulations Bettina!! So happy to hear your idea won :)

Photo of Bettina Fliegel
Team

Thanks Karine!  It was great to get support from the NYC Chapter during the challenge! Thanks for facilitating this with Anne-Laure Fayard .

Photo of Robert Smith
Team

Congratulations Bettina on your Top Idea!

Robert

Photo of Bettina Fliegel
Team

Thanks Robert!

Photo of Dawn Feldthouse
Team

Hi Bettina Fliegel ,

I have really enjoyed watching the evolution of your concept and how it evolves as you gain new insights from user testing. Our last OpenIDEO meet-up was really inspiring as we ideated on your most recent prototype. I think it would be fun to do user testing of our All-Terrain cane on one of your courses. That could be a really fun and informative experiment. I know you've seen it, but our updated description of our All-Terrain Cane can be found here: https://challenges.openideo.com/challenge/fall-prevention/ideas/a-new-all-terrain-cane

Photo of Joy_Chokchai
Team

Hello Bettina!

When we were discussion ideas during the meet-up, I really thought the idea of having different shapes/colors and the ability to place them indoors or outdoors was a great idea. I think you will be able to reach out to a larger number of participants that way. Good luck and hope to catch up with you soon!

Photo of Bettina Fliegel
Team

Thanks. I look forward to staying in contact!

Photo of eldy wullur
Team

It is time we give more facilities for the elderly in public places. During this time there is such a play ground is for children. This is a very interesting idea I hope the government and entrepreneurs are more keen to see this opportunity.

Photo of Bettina Fliegel
Team

Thank you for your support Eldy!

Photo of Raheema Hemraj
Team

Hi Bettina!
Great idea - I really love the intergenerational component of this and the idea of applying it to public spaces! I saw that you were working through different patterns for the 'obstacles' and wanted to recommend perhaps placing these to model specific balance exercises - i.e. just like your straight line activity, which is essentially encouraging tandem walking. The Otago exercise program, for example, has a good group of balance exercises which you might be able to simulate.
Raheema

Photo of Bettina Fliegel
Team

Thanks for the thoughtful suggestion Raheema! I will look at the Otago Exercise Program for ideas!

Photo of Grace Park
Team

Hi,

I really love the idea that this can be implemented in a public park setting. At the refinement meeting the other day, I remember someone said the level of difficulty should be adjusted/scaled in a way that provides the users a safer and reasonable level of exercise (i.e. users should have to pass an easier pathway to access a difficult pathway).

When I used to live in Korea, there was this park my parents used to take me that had a pathway of sorts for the purpose of exercising the bottoms of feet- the pathway had different types of pebbles embedded in the sidewalk. Every few feet, a new type of rock surface would be on the path, and although some rocks were harder to walk on, the level got more and more difficult as you went on the path. There were also several exits during the path so users could leave whenever they felt they reached their max. In addition, the entire pathway had support railings on the sides.

Thought this might help with your future vision for this project!

Photo of Anne-Laure Fayard
Team

Grace Park Thank you for sharing the park example. I think it is very relevant for Bettina's idea: the different types of pebbles remind me of Bettina Fliegel thought about using different types of material; the different levels of difficulty but also the ability to exit easily. I think this last point is really something important to keep in mind. The railings would also be a great addition. Thanks again for this inspiring comment!

Photo of Bettina Fliegel
Team

Hi Grace!
Thanks for coming to the meet up and for this thoughtful comment! It is fascinating to learn about different cultural traditions regarding wellness. Your comment makes me wonder if certain communities of older adults might be more apt to adopt this idea, or might be early adopters of the idea?

I looked at some images of these paths online. It was great to see how they are situated, the paths and rails, and to see people using them. They are beautiful!

I agree with Anne-Laure Fayard that the note about having multiple exits is important!

Thanks for sharing.

Photo of Sepehr
Team

I enjoyed seeing the kids interacting with the elderly in an inter-generational environment such as the playground. Perhaps, this field of obstacles could very well be implemented in such an environment.

Looking at this field of obstacles, it would be nice if there were a set of rules that went with every single obstacle. These set of rules could very well make the game a lot more enjoyable for adults and children. And perhaps children and adults could pair up?

There are a lot of possibilities. It's a good cheap alternative to the high tech tools such as virtual reality headsets.

Photo of Bettina Fliegel
Team

Hi Sephyr. Thank you for checking out the post and for the feedback! I envision different sections in a path. Sections for walking, maintaining a good walking pace where obstacles are separated by many strides and sections where they are closer together, in patterns.
The sections with patterns could be areas for games, as you suggest with rules. In this way that part of the path can be used for balance training for elders, and also for play. Play might be amongst family members, and also between adults who might enjoy some friendly competition?

Photo of Anne-Laure Fayard
Team

Hi Sepehr nice seeing you on the platform. Great feedback. Like you I like the multi-generational aspect. It reminds me of a program in Japan I posted about during the research phase: https://challenges.openideo.com/challenge/fall-prevention/research/wake-up-hike-out-tune-in-move-it-learning-from-japanese-radio-exercise Bettina Fliegel your comment about the friendly competition made me think of the summer program mentioned in the article... It could be something to explore too.

Photo of Kate Rushton
Team

Hi Bettina Fliegel 

Thank you for all your hard work in this challenge and dedication.

All of the ideas posts are locked but the comments section is still open, so please feel free to look at other ideas and comment on them, seek feedback on your idea etc.

I know I have asked many ideators this question but I am asking again as some ideas pivoting in the challenge. Would you say your idea is Most Viable or Most Promising? How would the incentives associated with that Award (Most Viable/Most Promising) be helpful for you?

Photo of Bettina Fliegel
Team

Hi Kate. This idea would be in the Most Promising category. The benefits would help to further develop and prototype the idea. (The process will require input from medical professionals and designers.) Ultimately it will be important to have visuals that can clearly explain the idea to potential partners/sponsors. Design support would help with this too. Access to a range of caregiver feedback via the panel would be useful as the idea is for users of differing abilities and some may be accompanied by a caregiver.

Photo of Duncan Yorkston
Team

Hi Bettina,

This is a fantastic idea! I'm really impressed with your research, well done and good luck!

Photo of Bettina Fliegel
Team

Thanks!

Photo of Srijay
Team

Hi
As I was writing my response to affordability for the curbd idea, I realized that the power of your idea is in its simple use and low cost. Link to my submission: https://challenges.openideo.com/challenge/fall-prevention/finalfeedback/an-assistive-device-for-curb-elevation-detection.
Srijay

Photo of Monika Mann
Team

I also like the idea of themes and using local artists. I'd be careful about putting too much text on the pathway but I think letters, single words, or simple equations could work. Re. targets v. obstacles I often make obstacle courses for my patients when working on advanced balance training. We pretty freely use the foam squares and blocks that I put down as either obstacles or targets. I imagine that people can use painted shapes on the paths either way. Also to bring in cognition you could have instructions with different ways people can use the path. For instance sometimes I tell my patients to step ON all blue squares but step AROUND all red triangles. This is just a suggestion of different challenges that could be listed.

Photo of Robert Smith
Team

Hi Bettina,

I enjoyed reading through your completed idea!

I especially like the suggestion about having local artists offer designs for the graphical elements. Perhaps each could incorporate a theme, such as flowers, animals, lily pads, footprints, planets, etc. Higher-end, permanent installations could include metals, wood inlays, colorful pavers and/or stone mosaics. Maybe some would use them for moving meditations.

These could offer temporal or permanent beauty and functionality... Nice!

Photo of Bettina Fliegel
Team

Hi Robert.

Another idea, suggested by Karine Sarkissian  at a recent NYC OpenIDEO Chapter Meet Up, was to incorporate text on the ground as a way to engage and move two people along the path playing together. (See Attachment 5 linked in the post ) I liked the idea! Not sure how older adults might experience this in terms of how easy or difficult it might be to see text on the ground. How about using single letters as design elements? I bring this up in terms of themes. Perhaps themes could be related to local culture? (different alphabets)

I love the suggestion about moving meditation!

Thanks for your feedback!

Photo of Bettina Fliegel
Team

Hi Robert.
@Allan Goldstein recently saw a path which made him think of my idea here. He emailed me a photo just after I wrote the comment to you. Coincidentally the path has text on it! (see link) He suggested to think about digital media, so text can change, or maybe a chalk board - with "thought of the week?" https://docs.google.com/document/d/1TYZ2FqHNJ3hgfhD4ormF8f-6JqMNiXgCSLrW4ARDH-E/edit?usp=sharing

How about a community board for users to record and share "walking" goals and achievements? (Candy Chang's participatory public art inspires ideas!) http://candychang.com/work/before-i-die-in-nola/ )

Apparently there is spray chalk that one can use with stencils to print on the ground, so that might be interesting to test. (info via @Karine Sarkissian )

Team  Any thoughts?

Photo of Robert Smith
Team

Hi Bettina,

Interesting to think about how your fundamental idea may have morphed. Originally it focused on placing obstacles (things to avoid) which people could navigate around. Now, it sounds like the obstacles may have taken on a life of their own (as targets). (Not a bad thing, just an observation).

Also not surprising that the children in your videos intentionally aimed for the obstacles. Perhaps there is a parallel concept that could be inspired by this phenomenon (targets as opposed to obstacles). Either way, people can still practice their walking skills.

Letters as obstacle/targets could form words which help with memory/cognitive skills (although only from one end unless they're anagrams). Maybe even mathematical expressions (2 + 3 = 5) which could also apply to cognitive issues.

Your idea could take on a lot of forms! Robert

Photo of Angie Boisselle
Team

Hello Bettina,
Someone tagged me in this challenge. There are two primary things I would ask you to consider: 1) I agree with Kumi that the individual should not look down. It decreases safety awareness of the surroundings and slows the person down. 2) using different textures may actually increase falls because of proprioceptive and balance issues. One of the biggest contributors to falls in the home are area rugs because there is a change in surface. I worry that you would be opening yourself up to liability if people were attempting this without a trained physical therapist present to supervise. While it would be desirable to have in a park, it may be more feasible and safe to have it in a controlled environment. Keep working on it. Best of luck with your challenge!

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Hi Angie. Thank you for reading the idea and for the feedback!
For the different surfaces they would be either in different "lanes" along the same path, or they would be incorporated after a certain distance - like 100 yards of concrete, to be followed by a section of hard foam. There would not be small sections of different surfaces. From your feedback I think it would be important to clearly mark the surface change with signs.

Do you think these design ideas would be a hazard?

(I need to create a visual to explain these different thoughts, for path designs.)

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Sorry Bettina. I missed this post. Possibly help to clearly mark. Many elderly have low vision so your signs would be important. I don't think the distance matters. It is the change in surface itself that is a challenge.

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Bettina Fliegel great updates and amazing videos. I really love the co-design parts in your last user testing and the participation of the 5 years-old kid was so inspiring and generative. I guess you have a good question about how to keep this intergenerational aspect without having seniors being scared or at risk of falling. How to make this a shared space? I guess one option is to have two different paths like the 2 mats... but wondering how it could be implemented outdoor. It also makes me think of lanes when you go swimming: you have the slow, medium and fast swimmers but you also have the family lanes. Worth exploring. I think the idea of adding signs is a great idea. In terms of a pilot, I wonder if you could not try to contact this program at NYC Parks: http://www.cityparksfoundation.org/sports/seniors-fitness/ The NYFoundation for Seniors http://www.nyfsc.org/ might also be worth contacting. I remember we talked about looking at Senior playgrounds and contacting them. I was looking in NY and found this one for adults: http://www.nytimes.com/2012/07/01/nyregion/new-york-introduces-its-first-adult-playground.html Might be worth visiting... and seeing if you could pilot your idea there. It reminded me adult playgrounds I've seen in London when living there.
Here are a few articles that might be relevant. This one reviews some of the equipment: http://www.aaastateofplay.com/playgrounds-for-senior-citizens/
I also like the social / community aspect highlighted in this article (they also refer to multigenerational playgrounds which resonates with your involvement of children): http://www.huffingtonpost.com/2015/06/04/playgrounds-for-seniors_n_7452270.html
Sorry for missing our last OpenIDEO NYC refinement pop-up but glad to hear it went well.
Congrats on all these prototyping efforts and updates.
Looking forward to the next steps!

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Hi A-L. Thank you for the feedback and resources! Will review them soon!
It was a collaborative experience and it did feel like co-designing. Glad to know that this aspect was captured in the updated post.

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Hi Bettina

Great idea, I'm really looking forward to see where this is going in the future! :)

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Hi Bettina, I love the new prototype photos! And the edit looks great. Did you see that I edited the GOAL too? You may like how yours stands now and want to keep it, but I just wanted to make sure that the edit suggestion didn't get buried. Not sure if you are thinking of keeping the label on the kid's path. I'd probably leave it off and have people take whichever path they want. Great with the added line and using an architectural feature that is already available for support . . . talking the fence.

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Thanks Monika.
re: The KIDS mat - I am inspired by her creativity and imagination. Based on this prototype I like the idea of collaborating with kids to figure out how to make this experience engaging for them. Her idea brings to mind scale in terms of design - what feels like the "right size" for a kid vs. an adult. Also how can the path design and experience be open for this sort of imaginative play for kids?

No I don't see the edit for the GOAL. Please resend just that part.

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Hmm, I can’t find it either. My suggestion was to make the goal more implicit about fall prevention and improving quality of life. Something like: Goal: To decrease fall risk by improving mobility, balance and cognitive skills allowing older adults to live safe, active lives.
If you want to target community-dwelling older adults in this first pilot you might want to add something like: . . . in order to actively and safely age in community.

I see your point on the kid’s path. I think it's great.

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Thanks.

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Hi Bettina and team,

It is great to see the results from the latest round of testing. For some reason the latest videos have an error message - "This video is unavailable". Is this just for my computer or is anyone else experiencing this error message?

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Thanks for letting me know. I have been updating and need to make the videos public. Will do so.
Do you think I should move some of the bits from the main idea into attachments, and leave a basic outline?

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If you have time, it might be a good idea to move previous prototypes into the attachment section. This is just so it is clear where your idea is now and what the current thinking is.

I think the Incubator Club from the financial longevity challenge is a good example of this -
https://challenges.openideo.com/challenge/financial-longevity/top-ideas/incubator-club-for-credit-union-members

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I had made copies of my Idea Post and am linking them as attachments.
Attachment 1_ Original post with updates to May 20.
Attachment 2_ Full post through May 27.
I am in process of finishing updates.

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Oh, I would focus on the videos, Bettina. It is clear to see the progression of your idea in the submission and how StepWise has developed in response to feedback from older adults.

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Hi Bettina, Okay, I confess that I love editing. See what you think of this version of the first section. Feel free to take any part you may want of this version and adapt it to yours: This idea is to create accessible walking paths with simulated obstacles painted on its surface. Older adults can safely practice functional walking and balance skills on the path. There will also be areas for guided balance and strengthening exercises. Our goal is to decrease fall risk by maintaining and improving mobility and balance as well as engaging cognitive aspects important for safe walking. As skills build confidence, our intention is that older adults will walk more, enabling them to live independent and active lives.

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Thank you Monika! There is a character limit for that section so I took bits and combined.

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Wonderful, Bettina. Just let me know how I can help out. I look forward to working with you. Monika

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Hi Bettina, Okay, I confess that I love editing. See what you think of this version of the first section. Feel free to take any part you may want of this version and adapt it to yours: This idea is to create accessible walking paths with simulated obstacles painted on its surface. Older adults can safely practice functional walking and balance skills on the path. There will also be areas for guided balance and strengthening exercises. Our goal is to decrease fall risk by maintaining and improving mobility and balance as well as engaging cognitive aspects important for safe walking. As skills build confidence, our intention is that older adults will walk more, enabling them to live independent and active lives.

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Bettina, I like StepWise, although all could work.

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Monika,
Thanks for your valuable input! I am adding you to the team.

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Dear Bettina, Kate Rushton suggested that I look over your idea. I am a physical therapist and also have an MPH. I think your idea is great. I love its simplicity and adaptability. A thought I have that I think might enhance it is to have a railing running along at least one edge of the course. That way, people with balance deficits can work out on the course while holding the railing or having it nearby. You might also look at simpler exercises for older adults rather than the ones on the signs. Good luck and feel free to contact me if you'd like any other feedback. I've worked quite a bit in fall prevention both with individual patients and also on a population basis. monikamannemail@gmail.com

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Hi Monika. Thank you for reading my Idea and for your feedback and suggestions!
The idea of a railing came up in another comment, from Mariah Burton Nelson  , thinking about how this idea might work for seniors in assisted living situations, those who are less mobile and might use walkers or canes. She suggested creating a path in a hallway with a bannister for support. I like the idea of installing one outside to broaden usability of these paths. Perhaps there might be one section of a longer path designated for this purpose?

For exercises - I posted the sign images only to show how a sign might work to explain an exercise visually. The exercises will be chair exercises, so simpler and related to balance. They will be along the lines of what is outlined here:
http://blog.eskaton.org/exercises-to-reduce-your-risk-of-falling
What do you think? Signs can be created that show how to do these using a bench. I envision park benches, with backs, situated along these paths - for rest and/or to use as exercise stops - whatever a user chooses.

Question:
I met with 2 seniors this week to share the idea. One of the seniors told me she practices "walking in a straight line to practice balance" - at home in the hall of her apt, and also when she is out on the street. She is not heel/toe walking, just walking on an imaginary line. She suggested this be added as part of what is created on these paths. (drawing a line, with arrows, as a prompt) What are your thoughts on this? Is this a good exercise to promote balance?

(The 2 seniors gave me lots of feedback which I am summarizing to post.)

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Hi Bettina, I like this straight-line idea. Some might choose to use heel-toe technique; others might walk normally on the line itself; others might try walking backwards or sideways. Footprints drawn on the line could suggest possibilities.

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Thanks Mariah. I like that this leaves open choice, whim, and self challenge.
I am thinking that this Idea might benefit from a sign at the main entry point showing and describing what one might encounter on the path and what one might do with these visual cues, but ultimately it is up to one's imagination how they might "play" along the way. What do you think?

What do you think about the name of this idea? I called this idea stepWise. OpenIDEO transcribed it as walkWise which I also like. Then I was thinking maybe walkWell.

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Hi Bettina,

Yes, I like the idea of a sign offering possibilities and also encouraging people to make up their own routes or games. To make the path intergenerational and collaborative, the sign might encourage people to hold hands for support, or a child might hop or skip on the line. If these things can be conveyed with pictures rather than words, so much the better to welcome people who do not necessarily read that language, or read well.

As for names, WalkWise and StepWise are both fine.

Walk This Way also comes to mind. Conveys an invitation, a challenge, and a certain playfulness, at least to me.

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Hi Bettina, I concur with the idea of adding a straight line. I often have clients try to walk keeps each foot on one side of a straight line. Many people have talked about the importance of not looking down. I think there could be signs along the way as reminders. Also the exercises on the link look good and would work well holding on to a railing. I'm thinking that the back of a bench may be too low for most people. Again, I am very enthusiastic about your idea. It's simple, adaptable and can be used by people at various levels of mobility. Good luck!

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One other idea that you may have already thought of: I encourage you to test your idea out with seniors who are at different functional levels: Some who have no noticeable deficits in balance/ambulation, some who are community ambulators but need an assistive device, and some who reside in assistive living facilities.

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Hi Monika.
Thank you for all of your input! I appreciate your point of view that this can be used by people at various levels of mobility. That is my hope. And yes, I would like to test the idea with people of differing functional levels.

I wanted to get your opinion on surface materials. Yesterday we had an OpenIDEO meet up in NYC to review 3 ideas that are in refinement. I shared that the plan was to have different materials for the paths as a way to challenge users. Concrete (whatever a park path already is), foam like in playground spaces and maybe sand. This was suggested early on by Kumi and I thought it interesting and a great build on my initial idea. The feedback last night was that this might be too difficult and to keep it simple, use only one surface. Do you have any thoughts on surface materials?

One other question:
Do you have any thoughts on how to measure impact for this idea? Would monitoring repeated use be a way to start?

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Thanks for the tip about the railing for standing exercises!

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Hi Bettina,

We’re impressed! Nearly 80 comments?! We want to point out that not everyone will have time to read all the comments, so make sure you've included information that has helped shape or pivot your idea in the description of your idea above. Keep up the amazing collaboration!

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Hi Kate.
Thanks! I was planning to review the comments in order to summarize feedback in an attachment, as there are many ideas on how this Idea might exist in inside spaces.
 I will post key points that helped to build this Idea in the main post as you suggest.

I met with two seniors from my neighborhood this afternoon to share the idea, to get feedback. It was a rich conversation and they want to meet again to try out the idea. One lives with her daughter and 2 grandkids, 3 and 5 year old, and she hopes to bring them along so we can watch what they do with the Idea. I will post updates!

(On a separate note - I am glad to see you online and safe.)

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Hi Bettina,

It is great to hear how Walk Wise is progressing and the enthusiasm of the seniors in your neighbourhood. I look forward to seeing the updates.

Thank you for thinking of me. I hope you are well too. :-)

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Hi Bettina!

Really interesting idea! It reminds me of this post in the research phase except the reverse - Simple human-centered solutions: Design driven's solutions to make Parkinson's life easier 

It also reminds me of this image -
https://s-media-cache-ak0.pinimg.com/564x/0c/d8/22/0cd822e81e02bc04d6eb6e3d307a6d3a.jpg

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Hi Kate.
 Thanking for pointing me to this research post. I love the message, her intention, and her work!
Thanks for the image!

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that tedtalk on designing a virtual staircase solution for parkinson's is really inspiring. thanks for making us aware of it, Kate. I will try to incorporate such thinking in my problem-solving life.

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Hi Bettina,
I was thinking about Kate’s post on simple human-centered solutions for Parkinson’s patients. How about making the path “responsive” to each step? This may get really complicated, but for example, if the path detects that a person’s steps are weak/unbalanced in one type of surface, it can change the surface (to either hard or soft) depending on that person’s ability. Ideally the surface changes would be very subtle so that the user almost barely notices any surface change, but challenging their body’s proprioception. There are so many ways to make this a personalized experience, or keep it more simple by having standardized responses to given step patterns (which may not be as effective).

Check out the technology behind this “smart bed”, it may give you some ideas:
https://www.engadget.com/2015/01/06/rest-smart-bed/

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Thanks! I will check out the link.
Do you think this suggestion would be something useful in a rehab situation, to help someone with an injury, or after falling, or for general use to help maintain or improve walking skills overtime?

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What an exiting prototype. I've seen young people using VR environment and FALLING, because it is too confusing to our brain to see things in a VR environment but not being able to feel, smell or touch them. And what a geeat effort you are undertaking.

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Hi Angela. Thank you!

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Hi Bettina,

It is great to see the updates to your submission and the inclusion of rest stops in response to feedback from older adults.

It would be great to get the perspective of landscape architects on the idea in general and occupational therapists and physical therapists on both the general aspects of the idea and more specific technical aspects e.g. optimum stride length for older adults.

I wonder if some of our OpenIDEO members might have some insights such as Angie Boisselle @DeletedUser Monika Mann Faith Watari Clarice Torrey Pia Jonsson Lauren Sosa 

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Thanks Kate. I would welcome any feedback and thoughts on the idea!

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Hi Bettina - this is a great. I cannot wait to try this when you have launched it. You asked about who to talk to about spacing on the call. It was suggested PT/OT and ADA - great suggestions. Have you considered a user focused study to tickle out the details? You may find the the tall people want more spacing while the smaller less? Have you given any thought to making them "adjustable" depending on user preference? Just a thought.

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Thanks for the positivity and thoughts Chris! I think it would be a good idea to do a user test as you suggest.
In terms of adjustability one idea would be to create "swim lanes" where the spacing between obstacles could be different. The idea of "swim lanes" came up in an OpenIDEO meet up we had in NYC a few weeks ago. Joy suggested this as a way to create ways to use different materials, on one wide path. I wonder if having lanes where obstacles where spread out for different strides might be beneficial? This is not really adjusting obstacles per se, but it might differentiate the experience for different users.

Adjusting obstacles - Maybe this could be for an indoor space, where obstacles might be part of interlocking foam pieces or something like that?

Any other thoughts? Thanks for the comment!

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Hi Bettina,

Hope to see you on the refinement call this Friday at 9 am PST.

If you have any questions, please feel free to reach out to me, my email address is krushton@ideo.com

p.s. I read that it is going to be 30 degrees C tomorrow in New York. I hope you get a chance to enjoy the sunshine.

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Kate Rushton 
Hi Kate. When does refinement end? That is a holiday weekend here so I wanted to double check. Is it Sunday the 28th, or Monday the 29th? Thanks.

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Hi Bettina, Monday 29th at 5 pm PT. Kate :-)

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Hi Bettina,

We've also been thinking about making responsive/playful environments for seniors ( LITE-RAIL ), and really like the idea of placing features in public spaces (as a way of creating interactions between children and seniors).

Have you given any thought to also placing features like these inside of people's homes?

It seems like even adding features like these to carpeting or something similar could be a good way to reach people who have difficulty getting out of their homes very often (particularly in areas with inclement weather). It seems like even a few subtle lines could be enough to encourage people to be a bit more active and maintain their strength a bit more actively?

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Hi Josh.
Thanks for your comment! I had not really thought about this path idea for one's home. In terms of inclement weather I thought it might be something to create in a mall, where people go to walk in cold weather. I have thought about it also for inside senior centers.
Thinking about home use, after your prompt - I imagine there might be products such as the interlocking foam squares, used to make mats for small children to play on, that might be accommodated to this idea, maybe in a hall, or in a large room. Maybe for use outside on a driveway? Something to think about. Walking on foam is more challenging than on hard surfaces so that adds a dimension. Adding colored obstacles, making a pattern, on foam squares might become it's own unique at home product. I like your suggestion that a few subtle lines might create opportunity to move, be active, but I am not sure that one would want to permanently change the flooring. Even using masking tape on the floor could be a good prompt.
Are you thinking of Lite Rail on the floor?

With Lite-Rail I see the idea benefiting seniors who need to get to the bathroom at night. Some need to get there quickly. I imagine this urgency might be a cause of some falls. From my observation I think the need is to have a light source within reach - like wake up, roll over and reach the light. Also I think light is needed if the phone rings. Maybe Lite Rail can be on a headboard, a bed frame, or the night stand for someone to touch and make it easier to find the phone, or a light switch? Adding to that having a mechanism to light the path to the bathroom would be great.

What would it entail to have this in public places?

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Hi Bettina,

Have you thought about how you could scale? It might be interesting to get the perspective of a physiotherapists viewpoint from an older adults perspectives and your viewpoint as a pediatrician.

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I have thought a bit about scale through partnerships with local government, Dept. of Parks, Dept. of Aging - things like that. Joy , one of the NYC OpenIDEO Chapter members, mentioned connecting to senior living communities. I believe she has contacts through her work as a geriatric nurse. I had not thought of getting the perspectives you bring up, including my own as a pediatric doc. Interesting. I will give it some thought. Were you thinking of professional networks and advocacy?

I am going to look at Kaboom as a model. I think there are learnings there. They started out building children's playgrounds. I see that they have introduced multigenerational playgrounds too. Interesting, United Health Care is one of their partners for children's playgrounds. KaBoom is partnering with The Humana Foundation for the multigenerational playgrounds as per the Huff Post article linked below. (Humana is a for profit health insurance company, big in Florida. Not sure where else they are.)
https://kaboom.org/about_kaboom
http://www.huffingtonpost.com/2015/06/04/playgrounds-for-seniors_n_7452270.html

Just found this:
http://press.humana.com/press-release/current-releases/humana-humana-foundation-and-kaboom-announce-three-year-partnership-b

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Hi Bettina,

It is great to see all the development on your idea. Actually, I think between you, Joy and your team members there probably is the perspective needed for an intergenerational solution, especially with 2 weeks left in the challenge.

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We had a chapter meet up and shared thoughts with each other. I will follow up with Joy. I like the intergenerational potential but I also think some seniors may shy away from sharing space with small children, if they are unsure on their feet, and aftaid of falling. Will need to work through these ideas. We have another meet up next week too.

Joy has a very thoughful app in development. Looking forward to seeing her updates .

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Hi Bettina,

Great to see all the progress on the idea. The video footage of the prototypes is really helpful to see. It reminds me of this finalist idea from the financial longevity challenge - https://challenges.openideo.com/challenge/financial-longevity/top-ideas/all-generation-friendly-atm

I wonder if arrows could be used for the ‘paths’ to ensure the older adults use it correctly.

What are the next steps for your idea?

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Hi Kate.
Thanks. There are a few things I hope to do and to explore.
1) Create images or diagrams that can help to explain the idea.
2) Explore potential path designs. I would like to speak with a physical therapist to gain insight on spacing of obstacles, and on how patterns might be beneficial to training of fitness and balance. If not I can try to research this.
3) Tests
      Incorporating feedback, create a path with individual obstacles spaced out and with intermittent sections where there are groups of obstacles. Would be great to have someone who uses a cane or walker try it.
     Test materials - Have users walk on a yoga mat, or foam.
      Make the obstacles easier for users to see. Tuba suggested printing images of specific objects on vinyl, at the NYU Maker Space, and testing with these. I also thought to try simple shapes drawn in 3D.
     At the NYC OpenIDEO meet up last week one suggestion was to test the idea in a park where there might be a variety of age groups. Create the path and just observe how people might interact with it. See what people do. A few members and I hope to meet to do this.
   
The arrow idea is good. I will try it out. Thanks! Do you have any other suggestions?

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Hi Bettina,
Just a thought to your #2) Explore potential path designs. I just thought of how we used to use tip cones in our clinic. You can incorporate something like Robert's suggestion of using 3D items (movable and light) and have a physical therapist design a couple of different obstacles incorporating these items on the path/course. For example, the user can move and place the items themselves, according to the design provided and posted at the beginning of the path.

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Hi Bettina, I like the idea of testing in the park. It could get a lot of intergenerational use. Recently, I went to a Stately Home locally with my parents and nephew. My mum and my nephew following a trail of strategically placed animals and find a certain animal or count them. I wonder if something like this could be included to get an intergeneration element.

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Hi Kate.
Was that a game on the grounds of the estate or did your parents and nephew come up with the idea spontaneously when they saw the animals as they walked? They were animal sculptures?
Thanks!

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Just a game on the grounds. Although, my parents have created games with him.

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I will think about a simple prompt for a game to test, as well as observing spontaneous fun!

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Kumi,
Is the idea to use these obstacles to walk over or around? Are you suggesting this to create increased levels of difficulty because the primary obstacles are flat?
Or is the suggestion to create ways to engage older adults along with children? I think Robert was thinking about interactions with kids.

Thanks for all your ideas Kumi!

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I love this idea! I love that it has the potential for free and easy access. What type of expertise do you think you would need to leverage to design an effective pathway? Landscape architect? Physical therapist? What types of materials do you imagine would be used to build the pathway? Sand? Rocks? Concrete? High density foam (the kind they use in playgrounds)?

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Hi Kumi.
Thanks for the feedback and these questions. I had not considered material yet. Is it easy to walk on the high density foam? This product says it is a non slip surface in all weather which would be great. http://www.sofsurfaces.com/whysofsurfaces

For some locations it might be great to work with what is there to keep costs down, and paint directly onto the ground - concrete in most places I would think. The idea is that the entire path will be flat so users would feel safe and encouraged to use it. The "pretend obstacles" are painted on the ground. Ex - If the path area is all gray, any color one approaches needs to be negotiated, either go around it or over it. That is the basic idea.

Do you think a physical therapist would have thoughts on where to place the "pretend obstacles" and how wide to make them, so that a path could be designed with areas that are more challenging than others to negotiate? I was thinking to look to nature and the urban environment for ideas about obstacles.

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Yes, I think it is easy to walk on the high density foam. I've walked on it myself when I take my son to the playground. It is firm enough to walk on, has a tiny amount of give. I assume that it is designed that way to accommodate children who might fall during running or jumping.

The reason I thought the foam would be interesting -- I think having different types of surfaces within one path, in addition to the obstacles, would be great 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.

Definitely, a physical therapist would have great ideas on where to place obstacles. Generally, placing obstacles farther apart is easier, then narrowing them and bringing them closer makes it more challenging. You can try and search Google Scholar for some evidence based research on obstacles and balance training/fall prevention. Also, it is important that elderly adults look forward (not down to the ground) when they walk. Something to think about with the overall design of your path.

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Wow, thanks for all of the tips! That is a great idea - to include different types of surfaces to maximize the experience of balance training. I also think it has a lot of potential visually. It would be great to create an engaging experience!

I am updating the post with your suggestion to use different surfaces to benefit the training!

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Kumi,
What do you think of MJ's thoughts on using a projected image for indoor spaces? See her comment and my reply above. Thanks!

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Hi Bettina,
I think if the projected image solution can incorporate aspects of balance training, it would be really great (and probably more cost effective in the end?). I have some reservations about the potential loss of proprioception training without the incorporation of actual physical surfaces (concrete, sand, foam). If the surface for the projected image solution is assumed to be flat, then maybe you can try and incorporate various stepping patterns such as varied stride lengths, zig-zag patterns with varied stride lengths, step overs, maybe even a jumping on rocks pattern. This is kind of funny, but maybe look to hop scotch as an idea. If you think about it, it is a great exercise. It requires jumping on one foot, but you can also modify it and do it with both feet, if balance is moderate.

It would be very cool to simulate a busy/noisy city street to get the eyes and ears engaged, which is also crucial to proprioception.

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Hi Kumi.
You mention that it is important for elderly adults to look forward, not down, when they walk. What is this about? Do some of them tend to look down? Thanks!

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Hi Kumi.
Thanks for this feedback and ideas! Your input has been really helpful! I will try to speak with a physical therapist locally to think through some of your suggestions, thinking about the difference between what might be possible indoors vs. outdoors where we could use different materials. Going forward I will map out some thoughts on paper.

Funny that you mention hopscotch. I was thinking about that too! I was also thinking about children hopping over sidewalk cracks as another inspiration.

If you have time check out Michael's comment about using projected images of different scenery.

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Let's continue the conversation. I have added you to the team!

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Hi Bettina! Sorry for the very late response to this. I've been trying to get you a research-based answer to this, but I haven't been able to find one. But yes, as others have said, and within rehab, we always encourage everyone to look forward (not down) when we teach them proper gait mechanics. When people look down to walk, they have the tendency for poor posture, also it can be potentially unsafe to only look down, versus being aware of what's coming ahead of you (cyclists, running children, a staircase or level down, etc.). Looking down when you walk is also a sign of instability -- that one has to rely on eyes, not proprioception, balance, tactile awareness of foot to ground -- in order to ambulate safely. Also, looking down when you walk slows you down.

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Hi Bettina, yes, Michael's idea is interesting, and I also like the idea of projecting images on the walls, personalizing, etc. The personalizing part is neat -- not sure how complicated the logistics of all of that would be. The image projection on the walls will also be a good "distraction" to prevent users from looking down (I think). If I come up other thoughts, I will post.

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Thank you for adding me to your team! Belated congratulations to the refinement phase!

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Hi Bettina,

I'm intrigued with your prototyping story, complete with videos and quotes.

I'm still a big fan of the idea; however, now I'm mulling over the "but you have to look down" comment from a user. I've heard from Mom's physical therapist that looking down is a common habit they try to avoid, because looking down (often, at one's feet) contributes to poor posture and gait.

So I'm wondering how good posture might be incorporated. Could these steps be placed on walls, such that the "game" was to touch them with one hand or the other or both -- thereby requiring some lateral movement, which probably contributes to good balance?

In a high-tech version, the steps could make a sound when stepped upon (that famous video of stairs being retrofitted to look like and sound like a piano come to mind) but the beauty here is the low-tech, low-cost nature of this.

Another idea is to put stepping circles on the walls on both sides of a hallway; the obstacle course becomes the hallway itself. When the game is "on" (and the hallway cleared of other residents who might get inadvertently knocked over), participants could proceed down the hall touching the markers as directed, in effect richocheting from one wall to another.

Or maybe entire packs of colorful post-it notes could be affixed to the walls, and the game would require participants to take one note from each pad. This sounds playful and inherently rewarding, since people would gather evidence of success (the stack of post-its at the end.)

Just riffing! Perhaps will stimulate other (better) ideas. :-) Or something like this could be a 2.0 version/s, after the stepwise idea becomes wildly popular!

PS - Back to your original idea: Variations could include walking backwards, or sideways, or doing something between each step (touching a foot with a hand; reaching both hands overhead into a clap, etc. - depending on the agility of participants.

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Hi Mariah.
I like your ideas for hallways! There was an OpenIDEO meet up in NY where we looked at the 3 ideas in refinement from our area. Someone suggested placing markers on the path, aligned with where the obstacles might be, to alert a walker that they were coming to one. I think something like that might work as a cue in a hallway, where there are already walls. Outside on a pathway it might work but it is something else to build into the path itself. If they were built outside it might also create an opportunity to add signs that cue walkers to do some of the other movements you suggest - raising hands overhead, or touching toes etc.

I want to try to figure out how to create an outdoor experience that focuses on encouraging walking with confidence, with good posture, while negotiating whatever one comes upon on the ground. The issue with looking down was a concern when I heard it. It was very useful to learn this during the prototype. Kumi also pointed out that it is important for older adults to look ahead when they walk, in a comment below. The feedback during the prototype was that it was because the images were flat. At least that was the user's perception. That made me wonder whether drawing objects in 3D might help. Either simple shapes, sphere, cube, triangle - or maybe objects like rocks. I think spacing will also help overall. The quick test course I drew had many obstacles drawn close together. Maybe a next prototype might be a trial where there are obstacles drawn 5 - 10 strides apart. While on this walk one comes upon sections where there are small "obstacle courses" - maybe using different patterns and also maybe using arrows, or foot prints, to direct users to do certain things such as walking laterally. Maybe there is something like a hopscotch board, and we can write prompts on the ground - hop, jump etc.? Maybe there is a section with "stepping stones" and prompts to walk on them, not over them - so they will be walking over the space between the stones - but it will be fun?

I added a video to the top part of the post. It is about a senior playground in Barcelona. Did you watch it? There are some inspirations there.

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One of the users who did the prototype mentioned having rest spots along a path.
What if there are benches which can be used to rest, and also to exercise and strech, sitting and standing? Signs could be posted with diagrams for instructions. This fits in with your ideas for other exercise, in addition to walking.

resources.eskaton.org/fall-prevention
blog.eskaton.org/exercises-to-reduce-your-risk-of-falling

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Hi Bettina Fliegel ,

Congrats on being in Refinement! An intriguing idea, and a lot of interesting comments!

It occurred to me that if the obstacles were cut from colored rubber (non-slip, maybe 1/2 inch thick) they might be simply placed on the ground at random, then either the seniors could move them about with their feet, canes, etc or visiting children could move them about, changing up the pattern for varying practice.

They could even interlock like puzzle pieces to make different size/shape obstacles.

All of this might work best in a somewhat 'controlled' environment so as to discourage their removal.

Fun to think about...

Robert Smith 

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Hi Robert.
Thanks for checking out the idea!
  The interlocking puzzle pieces sounds interesting, especially for an indoor space, maybe at a site where children visit grandparents? I am not sure about having them 1/2 inch thick, although I guess they would have to have some thickness. The basic idea was to have flat obstacles, to keep fear of practice, fear of possibly falling, out of the idea. It would be nice to test the idea of pieces that can be reconfigured though. Thanks for the idea!

Team  Any thoughts?

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Hi Bettina! I love your idea and the recent low-tech prototypes you've added in the refinement phase.

I wonder what a prototype would look like for those who use mobility aids and/or an older adult doing this with a child? Perhaps 3D obstacles may pose more of a challenge such as colorful pylons?

You're aware of the need to minimize fall risk during the challenge. I noticed in your second prototype cyclists using the same path, which may pose a challenge, depending on where these paths are located. A recent comment suggested a controlled environment, which seem prudent. You may also want to add something like stability bars, for those that are not using mobility aids in case support is needed along the way. Looking forward to seeing your idea move even further!

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Hi Nita.
Thanks for the comment! It would be nice to share the idea with people using walkers or canes to get feedback on the idea and to test it, see how their experience is. I will try to get some feedback.

Mariah Burton Nelson suggested the possibility of creating obstacle paths within senior living centers, and one idea she had was to create a course on a hallway where there is a guardrail. (or putting a guardrail in?) I hadn't thought of stability bars outside but why not? It might be a good idea, if there was a long walking path, that different sections might cater to different abilities. One part might have a guardrail for people who need that, at least to start. Thanks for the suggestion!

The bike/ walking path where I did the prototype is pretty wide. Ultimately this idea would be exclusively a pedestrian path for safety. I will add that to the post to clarify.

The plan is to go out again, with a few members of the NYC OpenIDEO Chapter, to a local park and set something up to observe how people might interact with this idea on their own. Hopefully there will be a mix of age groups in the park too - including kids. We were thinking to try a few different ideas to test what is easy for users to see, since the plan was to have flat obstacles. Are you suggesting colorful pylons to walk around? A few people suggested obstacles that one might move, reconfigure, in the comments.

Thanks for the feedback! How is your project going?

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Hi Bettina Fliegel , absolutely. I'm having a blast working with you too. (Though "real work" and life interferes now and then! :-)

I'm going to visit my elderly mother and stepfather in mid-May, and look forward to running some of these ideas by them in person. At very least, they'll be happy to know that smart people are working hard on solutions to problems they're very familiar with, and that AARP is fully supporting these efforts. I've already told them some of this on the phone but I think they'll understand more when I walk them thru some of these ideas and images on this site. Some real live user feedback! Could feasibly even create a prototype obstacle course for the one who is still ambulatory. Will let you know how it goes. I've learned not to get my hopes up - they once fell asleep when I was reading them a cherished essay that I wrote, alas! :-) but will let the team know if I learn anything valuable. Thanks for all your encouragement, good questions, and good ideas.

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Hi Mariah. Sorry for the late reply. Real life has been busy lately!

Thanks! It would be great if you shared the idea with your family and tested it if able to. I did some low tech prototypes with colored chalk outdoors. If you are indoors maybe use tape, like artist tape or masking tape, to make a couple of shapes on the ground? Would love to hear what they think about the idea in general and how it might adapt to their lives now. I shared a few ideas in refinement to seniors on my computer as well.

(I had a LOL moment when I read your comment.)

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I like thinking about how to integrate intergenerational activities for StepWise. Maybe you could change up the shapes and colors to make it friendly for younger children.

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Hi Amy.
Thanks for checking out the post and commenting! I like your suggestion.
I did a small experiment earlier this week. Using color chalk I made a short path/course with different shapes and had some older adults just try it. See post. I think color and shapes will attract children too. I wonder whether there is a need for "activities" or they will create their own experiences? Thoughts?

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Not only a fun activity for aging people, it promotes safety and wellness. Great idea!

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Thanks Allan!
I see these paths in city parks where people might find and use them naturally, motivated by fresh air and wanting to move, stay active. Do you have any thoughts on motivation or engagement for this idea?

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You probably know about the paths laid out in SE Asian cites for blind people, whic of course encourages their independence and getting out of the house. People like to follow along a path without giving it much thought, such as an unanticipated rock and any kind of uneven terrain. And if on a path, one is not isolated--someone will find you if lost or fallen down. The path provides a fine meeting place within a park. Meanwhile, the path may be sense oriented, a la lilac trees to anticipate in late April, roses at another time--an aromatherapy path, and other senses too, including touch of leaves and sound of wind through those leaves. You are providing an holistic experience.

I remember the Botanical Gardens in Capetown--the paths had a rope alongside for the sight-impaired to follow.

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I agree with you. People like to wander on paths. I love your description of possible sensory experiences that might happen along the way!

I am not aware of the paths for blind people in SE asian cities. Do you have any references?

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I was on one in Hong Kong this past New Years--it went through a park leading to the public swimming pool. My Chinese students often comment on the existence of the paths in their home towns. the path I was on was bubbled, which made me wonder how a person navigated the path with a stick. I didn't have the opportunity to observe a sight-impaired person use the path.

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I love this idea!

I'm thinking about my 80+year-old relatives who live in assisted living, and they happen to be formerly athletic people who still thrive on goal-setting, challenges, and even competition (such as Wii).

Unlike Wii, this is appealingly low-tech and inexpensive, with a deliberate fitness-boosting goal. (They tend to see Wii games as just games.)

With messaging that could indicate that it can help improve balance and prevent falls while also promoting fun, whether alone or in groups... I'm all for it. Kudos.

Bettina, thanks for calling my attention to it.

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Hi Mariah. Thanks for the feedback. I appreciate it! What do you think of using different materials? Do you think your relatives would be able to walk in sand safely?

I like the possibility of fun. I imagine if it is well designed using color it might be very inviting.

Not sure if creating a mechanism to follow one's progress over time is necessary. Maybe that would be something to work out with potential users?

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Hi Bettina,

Good question about sand. Sand would provide additional challenge and therefore interest. Also it would tend to cushion falls - but of course we don't want falls!

Maybe if this "obstacle course" (as I'm thinking of it) were to be installed/drawn/constructed in a senior residence, there could be a few levels to choose from - one on a firm indoor surface, one on sand, one on grass, one in a hall next to handrails for support, one designed to be used with a walker, etc.

I can imagine that these progressively difficult levels would provide interesting navigational challenges and multiple opportunities to feel successful - plus an appealing promise or prospect of improved balance, coordination, strength. (Hope of improvement in physical abilities is so important!)

Of my two relatives currently in assisted living, one (a fan of Wii) would be interested, tho he would probably bring his walker for security - not a bad thing, when needed. The other needs a wheelchair at this point, but would have been very interested in the past.

Which brings to mind: a scooter version of the game/obstacle course (navigating around orange cones, for instance) could be added, since scooter-drivers need dexterity, alertness, effective driving/stopping/steering skills, etc., and might also want "in" on this game.

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Thanks for these ideas Mariah!
I would love to see this path outside, in community spaces, parks etc. There was a research post on playgrounds for seniors. I love that idea as a way to promote health and combat isolation. http://www.huffingtonpost.com/2015/06/04/playgrounds-for-seniors_n_7452270.html
I also like the idea for indoor spaces to increase reach and can imagine this as an added feature in senior residences. I really like your idea for a guardrail in the hall and other parts of this experience in other spaces in/out of the residence. That would be cool!

Great insight about your relative probably bringing his walker. Sure! The path needs to be wide enough to accommodate people walking side by side as well, for socializing and for those who may want to walk with another to feel secure.

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Hi Mariah Burton Nelson . I have really enjoyed our conversations across the challenge! Thanks for your feedback and insights on this idea. I have added you to the team. Let's keep talking!

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Visually, this is a nice design idea for indoors or outdoors. But the placement of steps is very height-specific, and it might also require instruction sign to be posted as intended use would not be obvious.

However, As a modification to this idea, what about having it indoors and using lights to project the spots on the floor? I saw a video game sort of like that in Brazil's new soccer (futbole) museum. A small 4'x6' soccer field was projected on the floor. A soccer ball was also projected, and as children (around age 5-8) "touched" the ball image, it changed the direction of the ball, as in the old Pong video game. The kids chased this ball around as much as in a real game.

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Hi MJ. Thank you for the feedback!

The projection idea is intriguing! Thank you for sharing this! It could potentially turn any flat surface into a path or obstacle course. I think the idea could be great to use in a gym or courtyard space, particularly if an organization did not want to alter the surface of the floor. This might be a way to facilitate a practice path at certain designated times during the week. (The kid's game sounds great!)
The idea I had for this path is for it be a flat surface, with color painted onto the surface in different shapes and sizes. There will not be steps. The walkers would need to either go around, or over, these "objects'. (The image above is something I found on the internet, but that will not be the design. I will do a few sketches to give further examples.)

Yes, I agree that an instruction sign at the beginning of the path will be needed.

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Hey Bettina, Congrats on making it to the next round!
and thanks for incorporating my thought!
-mj lee

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Thanks MJ!
I have added you to the team!

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We get sponsors several times, and we went on a trip 5 big bus entourage and had a natural hot spring bath,
 Worship outside on the beach and they are very happy, like a bird that flies loose, free from a cage.

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Hi Bettina

I read through the post and the comments and a few ideas and questions came to mind:

What would be the incentive for people to use these paths/obstacle courses? Especially outside of nursing homes? If part of a program, how would the program work?

For ensuring the person keeps looking forward, a low budget way of achieving this could be by standing at the end of the course and asking them to maintain eye contact (then you can count each time they break eye contact). Of course you could just observe from another angle also for a more rough estimate of how often they put their head down. I'm sure there's no need for head-tracking or anything like that, and keeping it cost-effective is definitely a great aim.

I understand your desire to keep it cost-effective, and I believe that marking the ground is the best thing to do when outdoors, and there are of course other health benefits of being outdoors, so I would encourage this where possible. However, I do believe that the idea of using a projector for creating 'obstacles' has merit also, especially when indoors. It allows the course/path to quickly adapt to each individual's needs and abilities (you can have a different computer file for each individual, rather than re-drawing the course). This would also allow you to easily adjust the obstacle course over time (dragging obstacles closer together, etc.)

I was thinking you could project images of different places, just for a change of scenery (e.g. a waterfall trail, a beach, etc.). This could tie in with using different materials, e.g. when using sand you could project an image of a beach and sea. Not quite the total VR experience, but a much more budget and less intimidating method. Perhaps the scene could even be personal to each individual? Imagine projecting an image of their favorite beach as a kid, or a place they often went when growing up? Zooming in on Google Maps would make this very possible.

Perhaps there is also scope for you to tie in with one of the teams working on devices to 'catch you' when you fall and soften the impact? This could act as a training program, or if you want to make it into more of a game/challenge, one of those devices to help make it competitive but still safe?

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Hi Michael. Thanks for your comment and these ideas! In terms of incentive and motivation I was thinking that one might find these paths naturally, in a park, or in a senior center, and might be self motivated to check it out. Outside- motivated by fresh air and just by wanting to move, stay active. Also one might be motivated by the prospect of getting out, maybe seeing other people, socializing. Maybe one is motivated by competition - with oneself, the challenge, or with others if they use it in that way, as a game? Thoughts?

The idea behind this IDEA was the research I mentioned in the post. It was also inspired by a Research Post on this challenge which was about Senior Playgrounds. Check the articles I am linking below. I think I will link them into the post as well. I see this idea as part of this approach for seniors.

I think the video below really shows how open access to exercise and social opportunities can be very engaging for seniors and impact their lives positively. I showed the video to some seniors in the US. They liked the idea of these spaces as well and saw it as an alternative to exercising inside in a gym, weather permitting.

What if these paths were built near senior playgrounds, adding to the experience?
Or if the paths are built near children's playgrounds, where there are no senior playgrounds, creating opportunities for different generations to be in the park together, with different things for all to do?

http://www.huffingtonpost.com/2015/06/04/playgrounds-for-seniors_n_7452270.html

Check the VIDEO here:
https://www.pri.org/stories/2014-04-01/playgrounds-are-big-hit-spains-elder-set

Your ideas for projecting images are interesting! Just to clarify, you are suggesting images projecting scenery images on the wall, in addition to "obstacles" on the floor, correct? I like the image of that. Almost like an experience immersion. I can ask some seniors for feedback on that idea.
I like the idea of the flexibility of using a projector, being able to adapt a course either to individual need, or for different events.

I think it will help to see someone interact with idea. I hope to post a simple test soon.

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Hello Bettina,
A happy heart is a panacea that can cure various diseases.
In the case of special therapy to the elderly, we use the method of collecting some elderly
in regular meetings and encouraging them to tell stories of the past. This helps them drive off senility

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Team

Hi Eldy. Thanks for your comment. Maybe you can also take walks outside with the elderly and they can share stories as they walk?

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Hi Bettina,

Congrats on making it to the Refinement stage! Hope to collaborate with you soon :)

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Thanks Joy! Looking forward to it.

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Congrats Bettina Fliegel Let's see how we could start prototyping this idea!

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Great! Thank you!

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Hi Mariah Burton Nelson  Would love to get your insights on this seed of an idea.

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I love the simplicity of this idea, I also like that it could have a community aspect to it. As in having a group of individuals cheering each other on and supporting each other's progress.

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I like that visual of community and cheering each other on! Thanks Rima.
Do you think it would be beneficial to have a way to monitor one's progress over time? How many "obstacles" one's foot touched today vs. next week, the week after etc.? I am torn. I like the idea of this just as an experience, in the moment, maybe fun. I envision that within the design there will be easier and harder sections to negotiate so one can challenge oneself over time.