Nowadays, mobility means freedom, flexibility and autonomy for all citizens, including older persons. On the other side, aging is characterized by functional changes in the sensory, neurological and musculoskeletal systems, affecting motor tasks including gait and postural balance. Gait and balance disturbances in elderly are the main risk factor for falling. Every third person aged over 65 years is at the risk of falling or has had an experience of falling. These falls cause physical injury, emotional trauma and mobility avoidance. The most effective way to counteract falls is to improve movement capabilities. This may be achieved by training and rehabilitation programs focused to enhance or recover the performance of real life activities through the application of problem solving in normal situations (walking on rough grounds, standing up, climbing stairs, overcoming obstacles). A problem solving approach means to address motor learning processes by directly influencing motor behaviour, i.e. the way an action is designed and not muscular force or joint mobility only.

SMILING project implements such an approach through an innovative ICT system, able to change tasks to the user within his/her usual living environment.
Existing training and rehabilitation methods are based on movement repetition and correction or balance training for standing and not on problem solving for active walking. By applying conventional training interventions to improve walking in elderly at risk of falling some important factors such as the dynamics of the walking motor behaviour and the motor learning processes in the elderly are neglected.

The SMILING project plans to diminish age related impairments through the interference of diminished neural plasticity that limits walking ability and by continuing these functional improvements into real life situations. Research undertaken in USA and Israel has shown strong indications that the vicious circle of muscle weakness and time delay in the Central Nervous System (CNS) that causes gait and balance impairment could be weakened by applying unexpected external motion perturbations. These perturbations can loosen stiff walking patterns and hence introduce more flexibility into the motor control system to give improved stability.

Elderly people at risk of falling can be considered to be suffering from an involuntary and stereotyped motor behaviour that restricts their participation in society. One method to overcome such a situation is to break the stereotyped motion schema and activate a new learning process to better approach real life tasks in a better way. To pursue such a target, the SMILING project exploits chaos theory and dynamic systems theory with applications in the training of the ageing populations.

The SMILING solution, a wearable non-invasive computer-controlled system, performs chaotic perturbations to the lower extremities during active walking through small alterations of the height and slope of weight-bearing surfaces.

SMILING develops innovative training programs for elderly people, to be accomplished at home, in fitness clubs and health centres, with the aims of improving walking and balance, and to prevent and counteract falling.

The overall objectives are:
1. To develop and construct an advanced prototype of a wearable non-invasive computerized miniature system for mechanical chaotic perturbations of gait pattern in order to counteract and prevent tendencies to fall.
Two prototypes of wearable motorised shoes were developed to test their acceptability by elderly and their reliability in training as you can see in the pictures on the left. One was selected for a wider clinical testing on groups of elderly in four countries. The system is composed by a motorised pair of shoes driven by a devoted electronics; a wireless module to allow gait phases detection and complete walking analysis investigation; a User Control Unit to allow the subject undergoing training to manage his/her own training program.
2. To develop stimulation algorithms fitted to suit individual user's specific needs.
This part of the project is currently ongoing. A set of training tasks have ben identified and are proposed to elderly people for their validation. The aim is to identify which training paradigms may benefit from the SMILING system concept.
3. To implement a system for training to be spread in rehabilitation, health care and fitness centres for a reorganization of the rehabilitation process in ageing. Also if dissemination and exploitation actions are already approaching stakeholders in the rehabilitation field, this will be accomplished in the very late part of the project, when preliminary results from the SMILING system validation will allow to prove its acceptability and usability.