39 Protocol: gait-adaptability training in people with HSP Physical activity levels during daily life Physical activity during daily life will be registered via the Activ8 Physical Activity Monitor (Activ8, Remedy Distribution Ltd., Valkenswaard, The Netherlands). The Activ8 monitor is a small (30x32x10mm) and lightweight device with three axial accelerometers. It registers body positions (non-wear of the Activ8/lying, sitting and standing) and activities (walking, running, cycling).33 The Activ8 is placed by the primary researcher using TegadermTM tape on the right upper thigh of the participants. Interval for data sampling will be set to one measurement per fifteen seconds. Collected measures consist of total time spent walking (minutes) and total time spent active (i.e. minutes classified as walking, running or cycling). Activities-specific Balance Confidence scale (ABC) Balance confidence will be measured using the ABC. The questionnaire describes sixteen indoor and outdoor situations. Participants are asked to express their confidence in safely executing the proposed situations without falling. Scores range from 0-100, a higher score indicating more confidence. The ABC has been used to assess balance confidence in people with HSP.27, 34 The full questionnaire is available via Powell et al.35 Fall calendar The fall calendar is used to monitor falls and near falls and is self-reported by the participants during a fifteen-week period. The World Health Organization defined a fall as “an event which results in a person coming to rest inadvertently on the ground or other lower level.” A near fall is defined as “a stumble event or loss of balance that would result in a fall if sufficient recovery mechanisms were not activated”.36 In addition, participants register incidents where a fall was likely to happen, but was averted through the action of another person. When a (near) fall occurs, the participant is asked to report a short description of the event, the environment (indoor/outdoor, illuminated/dark space, and surface (e.g. tiles, carpet, forest)) and lastly, whether the (near) fall resulted in any injuries. To meet participants preference, calendars can be filled in digitally or on paper. Every other week, participants are reminded of the fall calendar via a phone call from the primary investigator (LV). Walking Adaptability Ladder Test (WALT) The walking adaptability ladder test (WALT) is a test to measure step precision. A standardized ladder is placed on the floor. It consists of 17 rectangular stepping targets that gradually decrease two centimeters in length (range: 64cm – 32cm). Participants start stepping in the largest target and walk as fast as possible to the other side, turn and hit the targets in reverse order whilst avoiding the ladder rungs. The instructions are to perform the test as fast as possible, but try to prevent foot placement errors. The test is timed: a faster time is indicative of better stepping 3
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