Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Print this page Email this page Users Online: 370

  Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 4  |  Page : 511-515  

Effects of mobile phone texting on postural control and gait parameters in college students


Department of Musculoskeletal Sciences Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission20-Jan-2021
Date of Decision23-Sep-2021
Date of Acceptance26-Sep-2021
Date of Web Publication28-Jan-2022

Correspondence Address:
Neha Kulkarni
Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune 411 018, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_36_21

Rights and Permissions
  Abstract 


Background: Mobile phone has become a part of everyday life. Mobile phone texting is one of the major causes of road traffic accidents, falls and injuries in young adults. Dual-task activities while using mobile phone increases the risk of falls. Objectives: To find out the changes in postural control and gait parameters while using mobile phone in young college students. Materials and Methods: A total of 100 college students of age 18–25 years participated in the study. NeuroCom Balance Master was used and the subjects were tested with and without phone. The participants had to maintain balance on firm surface and foam surfaces with and without phone. For walking, participants had to walk without phone followed by walking with phone. Outcome measures used were Modified Clinical test for Sensory Interaction on balance and Walk Across for balance and gait respectively. Results: The study showed statistically significant changes in postural control on firm and foam surfaces. Furthermore, the gait parameters such as step length, speed and step length symmetry were altered significantly, except step width while using the mobile phone. Conclusion: Subjects showed increased postural sway, step length and step length symmetry while the step width and speed decreased on using the mobile phone.

Keywords: Gait parameters, mobile phone, postural control, texting


How to cite this article:
Kulkarni N, Patel P, Joshi R, Gazbare P. Effects of mobile phone texting on postural control and gait parameters in college students. Med J DY Patil Vidyapeeth 2022;15:511-5

How to cite this URL:
Kulkarni N, Patel P, Joshi R, Gazbare P. Effects of mobile phone texting on postural control and gait parameters in college students. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Jul 5];15:511-5. Available from: https://www.mjdrdypv.org/text.asp?2022/15/4/511/336819




  Introduction Top


In today's generation, 77% of the world's population owns a mobile phone and prefer texting as a cost-effective method of communication. Using a mobile phone and doing another activity is a common example of dual-task activity which most of us do about anywhere. Cell phone use in pedestrians leads to an increased cognitive distraction, reduced situation awareness and increase in unsafe behavior.[1] Postural control requires integration of vision, vestibular system and sensory information.[2],[3] Young college students are mostly found doing dual-task activities like walking and texting on mobile phones, walking and listening to music.[4] Prioritizing the attention is required during dual-task activities. Researches show that students had reduced gait speed and swayed more on texting while walking.[5]

People who spend more time using mobile phones are likely to have incorrect positions of the neck, which might affect the proprioception input of the neck. Sustained pressure on the neck joint causes disturbed signals to the brain that might lead to balance problems and disturbed proprioception.[6] Cervical proprioception contributes to correct head in space and trunk orientation, as well as correct body orientation and balance control.[7] Postural sway is the horizontal movement of the center of gravity when an individual is standing still.

Mobile phone texting not only blocks the visual inputs but also, due to prolonged neck flexion disturbs the proprioception through the neck which controls the head position with respect to trunk and environment. Both, these factors together cause balance issues and hence, the risk of falling increases. Few studies have shown that gait parameters indeed are altered when a person uses phone while walking. Very few studies have shown that there would be balance issues as well. Hence, the need arises to look into the postural sway imbalances with gait parameters alteration while the use of mobile phone texting.


  Materials and Methods Top


Ethics

The study was approved by Dr D. Y. Patil College of Physiotherapy Institutional Ethics Committee. All the participants gave written, informed consent.

Participants

Using the Primer software, alpha error of 0.050, detectable change of 0.027, desired power of 0.800 was set by which a sample size of 100 was calculated. Participants had to undergo screening according to the eligibility criteria, among which, young college students between age 18–25 years (75 females and 25 males selected conveniently) provided written, informed consent. Participants with any musculoskeletal, neurological, balance, and coordination issues were excluded from participating in the study.

Procedure

The participants who gave the consent were assessed for postural sway and walking under two conditions, that is, without the phone and with the phone along with texting. Modified Clinical Test of Sensory Interaction in Balance (CTSIB) and Walk Across component in NeuroCom Balance Master System was used to evaluate the postural sway and gait parameters, respectively.

Modified Clinical Test of Sensory Interaction in Balance for postural control

The CTSIB is a low tech version of the Sensory Organization test developed by Shumway-Cook and Horak.[8] It utilizes firm surface and a medium density foam surface. Six conditions are tested. A simpler to perform Modified CTSIB also exists. It utilizes four different conditions eyes open and eyes closed on flat surfaces and foam surfaces. Times in balance and increased postural sway or loss of balance are recorded.[9]

The participant was asked to stand in a normal stance on the force plate in such a way that the heels were placed over the “M” line and the toes were in the outward direction. The participant was asked to maintain the balance with eyes open followed by eyes closed on the firm surface. The participant stood then stood with a normal stance on the foam surface, similar to standing on the force plate and was asked to maintain balance with eyes open followed by eyes closed on the foam surface. This procedure was performed by the participant without the phone. Later, the participant performed the same procedure in a similar manner, on both firm [Figure 1] and foam surface [Figure 2], but with texting on the phone. Each participant was dictated with a text to be typed by the investigator during the testing procedure. Three trials of 30 s of each task were taken and recorded in the system. The use of any strategies like ankle or hip strategy was also documented in the system. The task was stopped if the participant lost balance, required assistance or complained of nausea or dizziness. Any changes in the postural control between the conditions of without phone and with the phone were recorded in the system. The unit of postural sway measurement was degree/second.
Figure 1: Postural sway assessment on firm surface with mobile phone

Click here to view
Figure 2: Postural sway assessment on foam surface with mobile phone

Click here to view


Walk Across for gait parameters

Walk Across component was used to evaluate the gait parameters in two different conditions: (1) Walking without texting (2). Walking with texting. The participant was asked to walk across the force plate in a comfortable pace, first without texting on the phone [Figure 3] then with texting on the phone [Figure 4]. The gait parameters like step length (in cm), step width (in cm), speed (cm/s) and step symmetry (in %) were recorded in the system and used to identify any alteration in gait parameters during the task of walking without texting and walking with texting.
Figure 3: Assessment of gait parameters without phone

Click here to view
Figure 4: Assessment of gait parameters while texting on phone

Click here to view


Statistical analysis

Statistical analysis was performed using the statistical software WinPepi and Primer. The investigator initially used WinPepi software where Shapiro–Wilk test was done to find out the normal distribution. Primer software was used where Wilcoxon Signed-rank test was used for all the outcome variables of postural sway and gait parameters and the difference between without phone and with the phone was calculated (P < 0.05). The test was followed by descriptive statistics to analyse the mean and standard deviation of all the outcome variables.


  Results Top


The study included 75 females and 25 males with normal BMI and mean age of 21.34 years selected. The present study depicts that postural sway does change with the use of mobile phone for texting as depicted in [Table 1]. It is also seen that, on a stable surface, the sway reduces and on an unstable surface, it increases. The Gait Parameters depicted in [Table 2], also were affected in such a way that, the subject started walking slowly, unevenly with wide and shorter steps.
Table 1: Changes in postural sway of the young adults with and without the use of phone and texting

Click here to view
Table 2: Changes in the gait parameters after texting on phone

Click here to view


There is the significant reduction in step length and speed while the increase in step length symmetry after texting on phone. Furthermore, the step width increased with P = 0.072. This shows that the subjects started walking slowly, with wide and short steps unevenly.


  Discussion Top


The purpose of this study was to find out the effects of mobile phone texting on postural control and gait parameters among college students. The students belonged to the age group of 18–25 years, NeuroCom Balance Master was used to assess the balance and gait parameters like step length, step width, speed and step length symmetry of the students. The results were analysed using the Wilcoxon Signed-Rank test and descriptive statistics. The study showed changes in the postural control and gait parameters while texting on mobile phone.

The postural sway altered on using the phone on a foam surface. Postural control requires integration of vision, proprioception and vestibular system. On the firm surface, only the vision was blocked through using the phone and not the somatosensory system. Whereas, the postural sway was increased on the foam surface because the visual, as well as the somatosensory system, was blocked while using mobile phone.[2] This might be because the younger population is highly adaptive to immediate and can maintain postural stability to any change, especially when challenged with dual tasks like walking and texting, walking and listening to songs, walking and talking in their everyday life.[5],[10]

Nurwulan et al. conducted a study on the effects of mobile phone texting on young adults which concluded that texting affected postural stability and it is perceived to be more difficult as the changes were significant in all the tasks.[11] According to several studies, the vision is blocked while using mobile phones and so is the cervical proprioception due to prolonged neck flexion, leading to the negative impact on postural control.[2],[3],[4],[12]

Human locomotion requires a harmonious interaction between the nervous system, musculoskeletal system, visual system and the environment. Performing dual tasks reduces the quality of performance as the attention is divided among the tasks.[10] Schabrun et al. conducted a study to find out mobile phone texting effects on gait and implications of safety from which he concluded that gait parameters were altered while using mobile phones affecting the safety of an individual.[13] Our study had similar results because the gait parameters like step length, step width, speed and step length symmetry were altered while using mobile phone.

Graph 2 represents the mean of step length while walking without phone and walking with phone and shows that step length decreased and showed significant change (P < 0.001) in walking with phone. Graph 3 represents the step width changes among walking without phone and walking with phone which shows that step width increased during walking with phone. However, the change observed in step width was statistically insignificant (P = 0.072). This conveys that while walking with phone, the participants used the wider base of support.

The mean of speed while walking with phone showed a significant reduction in the speed of walking. The change in speed was statistically significant (P < 0.001) while walking with phone. Walking and texting is a complex task which demands more attention compared to only walking. The task of walking and texting involves the combination of walking, thinking, understanding and comprehending the text message and doing the fine motor task of typing.[10] According to research by Shumway Cook and Wollacott, task complexity determines the need for attentional resources for a given task.[14] Motor adaptation rates are affected even in healthy adults while demanding a complex task leading to a reduction in the quality of performance.[10],[15]

Similarly, in this study, while demanding a complex task of walking with texting, there was the alteration in the gait parameters. The step width and step length symmetry increased while the step length and speed decreased. This shows that while using mobile phone participants took shorter and wider steps, walked slower and with broad base of support. Due to the distraction from texting while walking, these changes in gait parameters were observed. Studies show that pedestrians distracted while walking (visually) tend to reduce their walking speed by adjusting the step length and step frequencies.[16]

Healthy young adults have good adaptability to respond to various unexpected internal and external changes and to anticipate the changes among the tasks.[11] Hence, the participants had reduced postural sway while using phone on a firm surface because they were able to maintain stability despite blocked vision as it is their day to day activity of using phone during other tasks.

Texting is the most common method of communication among youngsters. The feeling of anxiety, loneliness and self-esteem might be the issue with the students to use the mobile phone frequently.[17],[18] The significant differences between the situations of without phone and with phone in all the postural control conditions as well as the significant differences in step length, speed and step length symmetry, except step width between the situations of walking without phone and walking with phone showed that mobile phone texting has a negative impact on postural control and gait performance. Studies indicate that the use of mobile phones while walking is increasing the rate of accidents and injuries among young adults. College students use their mobile phones during dual tasks, in spite of being aware of the vulnerable injuries and accidents impacting their safety.[11],[15],[19] Therefore, college students are found to be more unsafe while using mobile phone while doing other activities.


  Conclusion Top


The study showed significant changes in postural sway while using mobile phones. Similarly, the gait parameters such as step length, step width, speed, and step length symmetry were altered while using mobile phones. Hence, mobile phone texting has a negative impact on postural control and gait parameters increasing the chances of falls and accidents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lamberg EM, Muratori LM. Cell phones change the way we walk. Gait Posture 2012;35:688-90.  Back to cited text no. 1
    
2.
Norris N, Hackney S, Bunn J. The Impact of Altered Visual Input and Auditory Stimulations on Balance and Postural Stability. Proceedings of the National Conference on Undergraduate Research (NCUR) 2016.  Back to cited text no. 2
    
3.
Palm HG, Strobel J, Achatz G, von Luebken F, Friemert B. The role and interaction of visual and auditory afferents in postural stability. Gait Posture 2009;30:328-33.  Back to cited text no. 3
    
4.
Sasaki O, Usami S, Gagey PM, Martinerie J, Le Van Quyen M, Arranz P. Role of visual input in nonlinear postural control system. Exp Brain Res 2002;147:1-7.  Back to cited text no. 4
    
5.
Strubhar AJ, Rapp B, Thomas D. Changes in gait and texting ability during progressively difficult gait tasks. Int J Exerc Sci 2017;10:743-53.  Back to cited text no. 5
    
6.
Park J, Kim J, Kim K, Kim N, Choi I, Lee S, et al. The effects of heavy smartphone use on the cervical angle, pain threshold of neck muscles and depression. Adv Sci Technol Lett 2015;91:12-7.  Back to cited text no. 6
    
7.
Armstrong B, McNair P, Taylor D. Head and neck position sense. Sports Med 2008;38:101-17.  Back to cited text no. 7
    
8.
Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther 1986;66:1548-50.  Back to cited text no. 8
    
9.
O'Sullivan SB, Schmitz TJ. Examination of Coordination and balance. In: Bezkor EW, Pappas E, editors. Physical Rehabilitation. 6th ed. Philadelphia: F.A. Davis Co; 2014. p. 206-41.  Back to cited text no. 9
    
10.
Atiya A, Khyati S. Reading and texting while walking: Effect on gait indicesin healthy young females. Int J Physiother 2019;6:23-7.  Back to cited text no. 10
    
11.
Nurwulan NR, Jiang BC, Iridiastadi H. Posture and texting: Effect on balance in young adults. PLoS One 2015;10:e0134230.  Back to cited text no. 11
    
12.
Horberry T, Osborne R, Young K. Pedestrian smartphone distraction: Prevalence and potential severity. Transportation research part F: traffic psychology and behaviour. 2019;60:515-23.  Back to cited text no. 12
    
13.
Schabrun SM, van den Hoorn W, Moorcroft A, Greenland C, Hodges PW. Texting and walking: Strategies for postural control and implications for safety. PLoS One 2014;9:e84312.  Back to cited text no. 13
    
14.
Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: A review of an emerging area of research. Gait Posture 2002;16:1-14.  Back to cited text no. 14
    
15.
Lim J, Chang SH, Lee J, Kim K. Effects of smartphone texting on the visual perception and dynamic walking stability. J Exerc Rehabil 2017;13:48-54.  Back to cited text no. 15
    
16.
Alsaleh R, Sayed T, Zaki MH. Assessing the effect of pedestrians' use of cell phones on their walking behavior: A study based on automated video analysis. Transportation research record. 2018;2672:46-57.  Back to cited text no. 16
    
17.
Gonzales AL. Text-based communication influences self esteem more than face-to-face or cellphone communication. Comput Human Behav 2014;39:197-203.  Back to cited text no. 17
    
18.
Skierkowski D, Wood RM. To text or not to text ? The importance of text messaging among college aged youth. Computers in Human Behaviour. 2012;28:744-56.  Back to cited text no. 18
    
19.
Banducci S, Ward N, Gasper J, Schab K, Crowell J, Kaczmarski H, et al. The effects of cell phone and text message conversations on simulated street crossing. Hum Factors 2016;58:150-62.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 1], [Table 2]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
  Introduction
   Materials and Me...
  Results
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed348    
    Printed15    
    Emailed0    
    PDF Downloaded21    
    Comments [Add]    

Recommend this journal