An Ethnographic Study of Balance
Lois Frankel, Concordia University & School of Industrial Design Carleton University, Canada.
Abstract
This paper presents findings from a qualitative study of the sensory changes in balance older people experience. They are classified under 4 sense of touch categories: the ability to sense movement (kinesthesia), the ability to perceive one’s body’s position in space (proprioception), the ability to feel pain, and the ability to make contact. The paper explores the potential for sensory anthropology to provide insights into sensory experiences that can contribute to more holistic product solutions for people’s evolving needs.
Keywords
Sense of Balance, Sensory Anthropology, Design, Older Adults, Inclusive Design
Introduction
My neighbour, Gregory, holds onto some support every slow step of the way from his front door down to his car in the driveway: the wall, the grab rail on the stairs, his cane, and different parts of his car. He tells me, “It’s enough for me to touch the wall and I feel steady on my feet.” This paper presents an ethnographic approach to understanding balance-related sensory experiences that older people like Gregory encounter. For example, his light and steadying touch provides proprioceptive[i] feedback, which is an important sensation for feeling balanced (1:74).
In her research in Ghana, Geurts observes the importance of the sense of balance. She surmises that Euro-Americans do not consider balance to be one of the senses because we are not conscious of the kinesthetic[ii] information we use to orient our bodies (2:7). Euro-Americans place less emphasis on the sense of balance and more on the mechanics. This study focuses on understanding people’s sensory experiences of balance as lived by them, not on the perspectives of medicine, psychology, physiology, or other applied sciences.
Balance is a multi-modal sensory process, “whereby three sensory inputs [vision, vestibular,[iii] and proprioception] are coordinated and integrated by the central nervous system, and the extraordinary ability of the brain to compensate for weakness or dysfunction in any one input [occurs] by increasing its reliance on the other two” (3:91). For example a person with an inner ear infection might have a reduced sense of proprioception, but not kinesthesia. When the eyes are open while walking, the sense of sight compensates to maintain balance.
One out of three Americans over age sixty-five and one out of two Canadians over eighty falls each year. (3:6, 4). This information is well known to designers who have been developing physical mobility aids for several decades (5, 6). Many aids are utilized after an experience of loss of balance. This paper looks to the recently emerging area of sensory anthropology to investigate experiences of older people in ways that might generate new design solutions. It is an effort to understand the whole picture of “bodily ways of knowing” about one’s balance (2: 3). Like Geurts, a number of anthropologists have studied other cultures to come to an understanding of how people prioritize their “sensorium”[iv] based on cultural experience (2, 7-9). This paper takes a sensory ethnography approach to gathering information that may lead to potential design opportunities.
Since the 1980’s applied ethnographic methods from the social sciences have been adapted for design research purposes to provide deeper awareness and understanding of behaviours that impact product design (10). By studying people in their usual physicaland social environments, performing with the tools they routinely use, and including their explanations and descriptions of their activities, ethnography produces knowledge that enables a designer to translate the users’ needs into appropriate product designs(10: 5). This preliminary study focuses on understanding older people’s sensory experience of balance with the intention of approaching design thinking at a holistic or system level.
Methodology
To explore how older people perceive and experience their sense of balance I interviewed five seniors ranging from age 70 to 84 in their homes. There were three women and two men, including one couple. A yoga teacher who works with older people was also interviewed in the yoga studio. The duration of the interviews was approximately one hour. All interviews were recorded, transcribed, and coded. The interviews were semi-structured, with pictorial props to spark further conversation. In addition three participant observation sessions took place: one mall walk and two yoga classes with less than ten students in them. All the participants signed non-disclosure forms. Their names have been changed to preserve anonymity. Their original interview material is presented verbatim, where possible.
The study uses constructivist and grounded theory approaches. All the data collected in interviews, through observations, and other ethnographic techniques was coded and analyzed. This approach provides opportunities to synthesize information into coded groupings that reflect participants’ experiences. According to Charmaz, “Learning what things mean to people makes what they do with them comprehensible-at least from their worldview” (11: 521). Moreover, how people act toward things in their worlds indicates the relative significance of those things to those individuals(11:521).
Findings
According to Classen, not only do “we learn what to touch, how to touch and what significance to give different kinds of touch”, but our sense of touch can be broken down into a variety of bodily sensations: the ability to sense movement (kinesthesia), the ability to perceive our body’s position in space and equilibrium (proprioception), the ability to feel pain, and the ability to make contact. (8:5, 12:13). Participants described or were observed having all of these sensations.
Kinesthesia
Harold told me about his kinesthetic changes: “My balance, my ability to balance and move in a straight line, knowing definitely where I’m going to be and how I’m going to end up has changed. I will veer to one side, ever so slightly, but I’m aware of the fact that there is some involuntary movement.” He was sensing a loss in his capacity to control his balance.
By the time Gregory accepted the fact that he could no longer compensate for his own wobbly movement, he needed surgery. He said, “Well I couldn’t walk. I had to hang onto somebody because, as I say, I was wobbling my feet.” I wanted to know, “Did it happen all at once?” “It was getting worse and slow […] and [on a trip] we decided to walk to the pub or a restaurant, and I just couldn’t. So that really hit me.”
What hit him? He could no longer access the familiar kinesthetic information he had relied on for most of his life. He went from compensating to a full stop. Gregory’s external habitus was changing. Our habitus is the social, cultural and physical environment that we as social beings inhabit, through which we know ourselves and others identify us (13:72). Gregory’s social relations with family and friends were becoming constrained by his personal limitations.
Whether a respondent was 78 or 84, the message was the same. These changes happen slowly, beginning sometime in the late 60s. In every interview people told me that they had walked, danced, cycled, skied, swam or exercised frequently in their younger years. Susan said, “When I had kids I could walk for miles.” Lee Ann said a similar thing about walking downtown to shop in Sarasota, “That’s about 4 or 5 miles, there and back down. So you see it was nothing for me to do this.”
Today most of the interviewees exercise in controlled-level environments. Gregory walks around the mall three mornings a week as part of a yearlong controlled study on arthritis. Harold and Barbara go to a local community center. She told me, “We definitely have modified our physical activity to suit the weather conditions. And one of the advantages of being at the Rec. Centre is that the environment in which we exercise is constant. You know, the temperature is constant, the airflow is constant.” They are no longer subject to the uneven terrain, irregular lighting, and slippery surfaces that undermine their kinesthetic ability to sense movement.
Proprioception
Gregory carefully navigated each step when he and I were heading out for our mall visit. He said, “I’m afraid of falling. I have a feeling that my knees will collapse under me when I go down the steps. I have the impression I’ve trouble bending the knee to make the lower step.” In fact he was the only interviewee who had not fallen, even though he was unsure about his body’s relative position in space (proprioceptive feedback).
Susan was still recovering from a fall she had taken the week before we met. “So I got out of the car and I went to lift my foot onto the curb and I just felt myself pitch forward.” Lee Ann’s fall was also sudden, “I went round to the corner of the bed and my feet just shot out and down I went.” Both of the women blamed their falls on an external factor- a loose sandal or a slippery floor. Like Susan and Lee Ann, most of us are not conscious that our bodies reorient in space, or that our sense of proprioception has slowed down.
Harold had a different insight into the cause of his fall, “Because really what we’re saying it’s the speed with which you can restore your body to a balanced position. And that becomes a major problem because your reflexes are slow. And so once you begin a movement in a particular direction, i.e. you stub your toe and it throws you off balance, and you start to move forward. That ability to correct is what’s missing.” The proprioceptive flow of sensory information is slower, and, “You never know when it’s going to strike. You never know when you’re going to be put off guard.” Harold’s bodily dispositions and his habitual behaviours have changed in response to his diminishing capacity to control his physical reactions.
As a consequence, the participants adjust their attitudes: fear of falling becomes a concern that restricts activities. They move more intentionally. They take up new activities on the advice of physicians, friends, family and popular media. Like Harold and Barbara, they may have a regime of cardiovascular exercise, indoor cycling, and yoga. Or like Gregory and Lee Ann they may take up mall walking.
Pain
Gregory slowly lowered himself into his chair using the armrests to take most of his weight. Lee Ann was similarly careful saying, “That’s why I got this one particular [arm] chair. I need something to push me up and then sometimes my knees are pretty sore. If I’ve been sitting here for a while, boy, I hate the thoughts of having to get up and then finally I force myself and up I get, you know.”
People told me about their arthritis, their sore knees, their weird feet, tight muscles, and their broken bones. It can hurt to go about one’s daily activities, especially if there is no support. Everyone had something to say about the stairs. A simple task like carrying something upstairs can be affected by sore feet, painful knees, and stiff hips. Gregory has an elaborate ritual for systematically moving parcels up the stairs one step at a time while using the railing to pull himself up. Harold and Barbara also use the railing, and have replaced unstable snack food trays with less precarious baskets. Harold says, “You are constantly trying to find, to see where the problems can be and then try to compensate before it happens. I mean that is why you’ll find that we, on the stairs up, a long time ago, put up railings on both sides.”
Lee Ann tipped me off about the secret for negotiating stairs and curbs, “ When you’re going up use the good leg, and when you’re coming down use the bad leg.” I interrupted her, “I’ve never heard that before.” She says, “Yeh and they tell you if you’re going to go up on a curb or something like that, to go up, step up, use your good – the strongest one, the strongest leg.” She calls it, “one-legging it.”
The participants have found ways to negotiate around the painful limits of their bodies. That way may be slower, it may be awkward, but it lets them achieve their objectives, mostly through the support of physical contact.
Contact
Gregory’s house has two floors. He has a different kind of rollator[v] on each floor, another in his car, and he has a cane at each door, “So that if I have to step out unexpected I’m prepared.” Harold has 3 canes, but he says he has 2. He showed me the cane his father-in-law carved for him, complete with travel stickers. He showed me his height-adjustable lightweight aluminum cane. I asked, “ So did you take one of these with you on your European trip?” “We actually had, no, we had ski poles.” There was number 3: a stability aid for Canadian skiers used unselfconsciously on the streets of Paris, no less!
Susan tells me, “I can’t stand in the middle of the room and put a skirt on anymore, you know, step into a pair of slacks. I need to lean against the bed or lean against the wall.” Gregory relies on the wall too, “There’s a long corridor there […] I don’t feel like pushing the walker. But I’ll just glide my finger along the wall and I’m quite steady.” His finger is like a cat’s whiskers providing “skin knowledge” or “tactile impressions” that sense the environment (14:28).
Over time, the participants rely on more tactile contact with the environment, things, and people around them. Gregory may have some sort of support from the moment he gets out of bed, throughout the day, and back into bed again. The canes, walkers, carts, railings and other supports may or may not be adjusted to fit his body properly. One of his walkers had belonged to his wife. Susan’s mother’s cane came in handy, “When I needed the cane I had it. I was using my mother’s cane.” Was her mother the same height as she is? Not likely.
Everyday the average person makes hundreds of judgments in which the sense of touch casts the deciding vote, whether or not it rises into the consciousness (15: 426). The participants’ tactile support solutions arrived in fits and spurts, building a sort of collage of gliding along, grabbing, holding, leaning, and stabilizing the body, augmenting the body’s changing capabilities.
Implications for Design
The saying, “you can’t see the forest for the trees” may be an apt metaphor for how many designers approach design for evolving sensory needs. We see the details of the problem, but sometimes miss the larger context. Ethnographic research methods have contributed to the design of better assistive devices andthis study confirms their importance in people’s lives. It also begins to highlight situations where we designers have not yet seen the “forest”, in which our products do not fully optimize the sensory challenges people are facing.
For example a perfect rollator would perhaps be more suited to a family of related products, or have interchangeable parts for different situations, or communicate with other assistive devices when it is time to make a transition from one to another.Subsequent research could include design concept development based on these types of findings. In the manner of Malnar and Vodvarka, a set of guidelines for the holistic sensory design of environments, systems, and inter-connected products for maintaining balance could be developed (16: 57).[vi]
Conclusion
Factors related to the sense of touch are key to the participants’ “bodily ways of knowing” about balance. First, they experienced kinesthetic, proprioceptive, and painful feedback. Then they responded with fear, intentional behavioural changes, and/or ingenuity. They improvised a bricolage - a patchwork solution- of contact within their own “sensorium”. In this project, approaches borrowed from the field of sensory anthropology are used to describe how aging people experience their changing sense of balance. This type of information can be useful in understanding the context of the design problem.
Some sensory anthropology perspectives can also be relevant for integrating older users into the design process through participatory methods. The deeper insight into sensory experience from a holistic point of view can contribute to more integrated product solutions to meet people’s evolving needs.
References
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2. Geurts KL. Culture and the Senses. Luhrmann T, OParish S, editors. Berkeley and Los Angeles: University of California Press; 2002.
3. McCredie S. Balance: In Search of the Lost Sense. New York: Little, Brown and Company; 2007.
4. Scott V, Pearce M, Pengelly C. Technical report: Injury resulting from falls among Canadians age 65 and over. 2005 [updated 2005; cited 2008 June 12]; Available from:
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6. Fisk AD, Rogers WA. Handbook of Human Factors and the Older Adult. Anonymous, editor: San Diego : Academic Press, c1997.; 1997.