Simone Gill (left) and her doctoral student Danny Shin are gathering data on the walking patterns of people following weight loss. Photo by Michael D. Spencer<\/p>\n
I<\/em>n 2017, Danny Shin,<\/span> an occupational therapist in inpatient care at a hospital, was working with one of his patients, a man with a movement disorder. The patient was doing particularly well, Shin (\u201922) recalls. \u201cHe never fell with me, ever, in the hospital.\u201d And yet, as soon as he returned home, the man took a tumble.<\/p>\n What happened? Shin wondered. \u201cPhysically, he was fine. He was safe to be home.\u201d Had the patient felt comfortable in a hospital setting, but lost that confidence when his environment changed? Or had he instead become overly confident and pushed past his limits? There was also a chance, Shin reasoned, that self-confidence wasn\u2019t a part of the equation at all.<\/p>\n Shin has been studying that relationship between self-confidence and walking at Sargent where he\u2019s pursuing a PhD in rehabilitation sciences. He\u2019s conducting that research in the lab of Simone V. Gill<\/a>, an associate professor of occupational therapy. Gill has spent a decade at BU studying the ways obesity affects walking patterns and contributes to fall risk, often working with people undergoing bariatric surgery. \u201cOne other thing, though, that goes into falling isn\u2019t just physically what you can do,\u201d Gill says. \u201cIt\u2019s how confident you feel about moving around. After individuals lose massive weight, it\u2019s like getting used to an entirely new body.\u201d The two have designed a new study that examines both the physical and emotional changes resulting from such massive weight loss.<\/p>\n \u0007People who undergo bariatric surgery can lose up to 35 percent of their body weight in a single year. \u201cI was very curious about what happens when there\u2019s a change in your body that\u2019s so sudden.\u201d Research has shown that people with obesity move differently, with a wider gait, than people with average body mass indices when walking on flat ground and navigating environmental obstacles. They tend to walk more slowly and take shorter, choppier steps; they also prioritize spending time on both legs, rather than balancing on one at a time. \u201cIt sounds like it should make them more stable,\u201d says Gill, \u201cbut it actually predisposes them to more falls.\u201d<\/p>\n Even after bariatric surgery, a patient\u2019s movements don\u2019t completely return to baseline. \u201cThere\u2019s an argument for rehab because their walking patterns haven\u2019t matched those of people with average body mass who never were living with obesity,\u201d she says.<\/p>\n Gill\u2019s interest in this research is, in part, personal. In 2012, she weighed 225 pounds; today she weighs about 130. Although she did not have bariatric surgery, \u201cI was interested in differences in how I moved after losing about 90 pounds.\u201d People who undergo bariatric surgery can lose up to 35 percent of their body weight in a single year. \u201cI was very curious about what happens when there\u2019s a change in your body that\u2019s so sudden.\u201d<\/p>\n For their study, Shin and Gill, who also directs Sargent\u2019s Motor Development Lab<\/a>, asked 12 adults prior to bariatric surgery to navigate five courses, which ranged from flat ground to high obstacles. Participants returned 4, 8, and 12 months after the surgery to repeat the course. A gait carpet tracked the position and timing of their footsteps, capturing digital representations of their footfalls as they walked.<\/p>\n At each visit, participants were also asked to complete two tests to measure self-efficacy: the belief that you can successfully complete a particular task. The first test, known as the falls efficacy scale, describes how confident a person feels that they can complete a functional, day-to-day activity\u2014such as cooking dinner or taking a shower\u2014without falling. The second test, called the modified gait efficacy scale, is newer and less commonly used. It tests for confidence in challenging circumstances, such as walking safely across a grass lawn or stepping up on and down from a curb.<\/p>\n So far, Shin is in the preliminary stages of data analysis. Early results show definite changes in walking patterns: after surgery, participants walk faster and with a narrower gait. Self-efficacy also shows a general improvement between the zero- and four-month mark. Examining these factors in concert is important, Shin says, because \u201cif someone has low self-efficacy, even if they are physically capable of doing something, a lot of people still choose not to do it.\u201d Walking is one of the least expensive and most commonly prescribed methods to combat obesity, yet patients often avoid it. This study could add another layer of data to help explain why.<\/p>\n Shin presented these findings at the annual Gait and Clinical Movement Analysis Society conference in March 2019. For Gill, that is an important part of the student experience. \u201cIt\u2019s an opportunity to learn how to disseminate his work to other scientists,\u201d she says. Another focus for Gill is to create a space where Shin and her other doctoral students can lead in the lab. \u201cThey have to learn how to be scientists, but they also have to learn how to mentor others.\u201d<\/p>\n
\n\u2014Simone Gill<\/cite><\/p><\/blockquote>\n