Everyday clinical practice and university research come together at Felix Platter Hospital in Basel, Switzerland, where the latest findings and advances in geriatric medicine are continuously being integrated into diagnostics and therapy. This makes the specialist hospital a showpiece for the structuring of modern geriatric medicine. In addition to rehabilitation, the specialists at the Mobility Center focus primarily on the prevention of age-related mobility restrictions.

The medical offering at the Felix Platter Hospital is divided into the fields of university geriatric medicine and geriatric rehabilitation, and covers almost all aspects of geriatric care, from acute treatment to outpatient specialist consultations for elderly people with gait disorders and increased risk of falls.
At the Basel Mobility Center of the Felix Platter Hospital, doctors, scientists and therapists work closely together to identify and measure mobility problems that occur in old age. The institute also offers the opportunity for outpatient assessment of gait and dynamic balance disorders, and carries out measurements to determine functional deficits in everyday life.

The Basel Mobility Center is dedicated to both the clinical routine with patients and clinical research with study participants. These areas are not separate, but intertwined – the insights gained from research should flow directly into the work carried out with patients.

Particular emphasis is placed on the early detection of mobility problems. Early detection enables the use of preventive measures, with the aim of keeping the elderly patient mobile and functionally independent for as long as possible.

Mobility consultation

Walking difficulties are not an inevitable consequence of age. There are many systems and factors that influence a person’s standing and gait pattern. Changes to these factors associated with age – e.g. vision problems, hearing loss, decreased muscle strength – are a challenge, given that they require attention to compensate for them and compromise stability and gait control. As a result, elderly people often experience an indefinable malaise, a feeling of unsteadiness when walking, concerns about activities that they used to be able to carry out automatically and with ease, or they may even feel dizzy.

These complaints are clarified thoroughly and in detail during the mobility consultation. The focus is on the ability to function in everyday life. In addition to medical history and relevant medical examinations, evaluations of static and dynamic balance, as well as functional ability in everyday activities, and possibly also a gait analysis, are carried out as required. The results can then be used to develop recommendations for therapy plans aimed at maintaining or improving individual functionality and mobility, as well as stability when walking, for the affected person.

The need is great, as mobility issues among elderly people are now among the main causes of falls. According to statistics, one in three people aged over 65 falls at least once a year. Broken bones are a frequent consequence, with femoral neck fractures being a particular source of concern. In many cases, these lead to a vicious circle of immobility and fear that can end in further falls, dependency on care, social isolation and death. At Felix Platter Hospital, staff work intensively with patients to break this negative spiral by precisely analysing the causes of falls, and remedying them with targeted therapeutic measures.

Gait analysis

Gait analysis is an important diagnostic element in this context. It helps to accurately identify fall risks while also serving as a modern fall prevention method. With the help of a "temporo-spatial" investigation, the gait pattern of persons at risk of falling can be analysed in detail even before a fall occurs, opening up the possibility of preventing a worse outcome thanks to individualised consultation and treatment.
An important tool in this case is electronic gait analysis (GAITRite®), which allows the spatial and temporal parameters of the dynamic gait to be quantified.

The measurements can also detect very discrete gait disturbances that are often unrecognisable to the naked eye. A special feature of such gait analysis is the investigation of neuromotor control of walking by means of measurements under dual conditions ("dual task"). Patients must perform a second task at the same time as walking. This could be, for example, reciting animal names or counting backwards. Not infrequently, patients initially show no anomalies in gait analysis, but suddenly become unsteady and almost fall when a cognitive task is added.

This is because certain changes in gait are associated with a risk of falling and/or with brain disorders. Gait analysis under "dual task" conditions is therefore also a suitable test procedure not just for identifying mobility disorders and an increased risk of falling in elderly people, but also for the early detection of brain disorders. This results in close interdisciplinary collaboration with the Memory Clinic at Felix Platter Hospital, where gait analysis is also an integral part in the diagnosis of dementia.

In practice, patients undergoing gait analysis are asked to walk across a ten-metre-long carpet that is connected to a computer via a cable. The carpet contains around 30,000 sensors that precisely record the subjects’ steps and tell the computer when, how and where the patients put their feet down. Parameters such as step length, cadence, stride width and other key values for the analysis and evaluation of the gait pattern are calculated with the associated software.

In order to be able to give patients direct recommendations for action, to help them improve their balance and steadiness when walking at home, Felix Platter Hospital has developed the "Better Balance" flyer – a self-training programme designed to improve strength, endurance, balance and coordination.

New research project launched with THERA-Trainer lyra

Felix Platter Hospital relies on state-of-the-art methods, not just in diagnostics but in therapy too. For almost two years, the lyra end-effector gait trainer has been used in the gait rehabilitation programe, allowing therapists and patients to benefit from the advantages of modern gait rehabilitation robotics.

The Mobility Center, under the direction of Dr Stephanie Bridenbaugh, launched a new research project with the gait trainer last year in collaboration with physiotherapists. At the Mobility Center, the medical director is currently supervising Master’s student Sandro Caminada, a sports scientist from the Department of Sport, Exercise and Health of the University of Basel. As part of his Master’s thesis, Sandro is examining the effects of training with the gait trainer on elderly people with restricted mobility in the context of a prospective intervention study.

The team sees great benefit in the work thanks to the pragmatic approach and the high clinical relevance. The results of the study are planned not only to be published later in a peer-reviewed journal, but also to be fed back as directly as possible into everyday clinical practice. In this way, physiotherapists obtain immediate feedback on which patients benefit from lyra training, how their functional assessments correlate with objective measurements from gait analysis, and how the patients get on after leaving the hospital.

The post-inpatient outcome of the subjects is particularly interesting for the researchers. In order to determine how patients are coping at home after rehabilitation, a follow-up visit takes place three weeks after they are discharged from the clinic. "This follow-up is particularly fascinating, because the time after being discharged from inpatient rehabilitation until potentially being re-hospitalised is still a black box", Bridenbaugh says. "If we can prove that lyra training significantly improves the mobility of our rehabilitation patients, and that its effects continue after the patients are discharged, this therapy option will inevitably become more present among physiotherapists and will, most likely, be used more frequently and in a more targeted way."

The results of the study are set to become available by spring 2018 at the latest.