On behalf of my co-author and myself, I would like to acknowledge Nordixx Canada for helping to fund this research, our participants for their time and patience, and our fellow colleagues, Jos&#233;e, Ria, Lei, and Nadia, for their help with various aspects of this study.

This study was performed in accordance with the guidelines of the Research Ethics Board of the University of Ottawa.
1. Screening Procedure
<ol>
	<li>Provide side show presentations to local area walking groups and post recruitment posters at community centers and public facilities in order to recruit a group of active, community-dwelling older adults.</li>
	<li>Upon initial visit, first greet the participants, introduce them to the laboratory, and provide them time to change into appropriate attire (i.e. shorts, t-shirt, and running shoes). Once ready, provide each participant with an in-depth study description, obtain written informed consent, and screen each individual for study eligibility using various questionnaires. 
	NOTE: Inclusion criteria includes: 55-80 years of age, novice to Nordic walking (NW), no neurological conditions, no cognitive impairments, no cardiac conditions, no previous injury or surgery affecting gait and upper extremity movement, and the ability to walk unaided.
	<ol>
		<li>Have the participant complete a General Health and Physical Activity Questionnaire and the Physical Activity Readiness Questionnaire (PAR-Q) in order to confirm age, activity level, any existing neurological conditions, and briefly assess cardiac health.</li>
		<li>Next, have them complete a self-reported postural stability and falls questionnaire (adapted from Ashburn et al.10) to determine fall prevalence, if applicable. Lastly, complete the Montreal Cognitive Assessment (MOCA) with each subject in order to control for mild cognitive impairment11, constituting a minimum score of 26 out of 30.</li>
	</ol>
	</li>
</ol>
2. Pole Set-up and Nordic Walking Instruction
<ol>
	<li>Provide each participant with a set of poles, and instruct them on how to adjust the poles to an optimal length relative to their height. Ensure that the adjustment corresponds to approximately 65% of the individual&#39;s body height.
	<ol>
		<li>Provide each participant with the following instructions regarding pole adjustment. Ask the participants to stand tall, have the participants place the pole tip in front of the toes, instruct the participants to place the elbow and forearm next to the body, and ask the participants to lengthen the poles so the elbow forms an approximate 90&#176; angle next to the body. Finally, securely tighten the poles and angle the boot tips backwards.</li>
	</ol>
	</li>
	<li>Instruct the participant the following 4 basic steps in order to minimize the amount of information to process and ensure a thorough understanding of technique12. Allot approximately 30 min for instruction and subsequent practice of the technique. 
	NOTE: Nordic walking instructions are to be given by a certified Nordic pole walking instructor.
	<ol>
		<li>Before securing the wrist straps, instruct the participant to place their poles behind the lower back and stand tall. Ask the participants to stand with their chest tall and the shoulders relaxed. 
		NOTE: Explain to the participant that this is done to gain an understanding of the required upright body posture for Nordic walking.</li>
		<li>Have each participant secure the wrist straps, place the pole tips behind them, and relax their arms at their sides. While keeping their hands open (i.e. not grasping handles), instruct the subject to begin walking with minimal arm swing for approximately 100 m. 
		NOTE: At this stage, the poles are simply trailing behind the participant.</li>
		<li>While still keeping the hands open and dragging the poles behind them, instruct the participant to begin walking faster. Ask the participants to visualize bringing their hand up as if they are about to shake someone&#39;s hand. 
		NOTE: At this phase, explain that the goal is to promote the natural reciprocal and rhythmic actions of the arms and legs during gait.</li>
		<li>Finally, as the arm swings forward, have the participant gently grasp the handle and apply a force against the ground. With each arm swing, instruct the individual to slightly lift the poles off the ground and firmly plant them with each subsequent stride. 
		NOTE: At this stage, explain that the applied force aids in progression of gait and provides resistance to the upper body musculature.</li>
	</ol>
	</li>
</ol>
3. Data Collection and Testing Protocol
<ol>
	<li>Using a standard tape measure, weight scale, and caliper, take the participant&#39;s anthropometric measurements, including height, weight, inter-ASIS distance, left and right leg lengths, knee widths, ankle widths, shoulder offsets, elbow widths, wrist widths, and hand thicknesses.
	<ol>
		<li>Using a tape measure, measure each leg length as the distance from the anterior-superior iliac spine (ASIS) to the center of the medial malleolus as well as the distance between the left and right ASIS (i.e. inter-ASIS distance).
		<ol>
			<li>Next, measure the widths of each joint using a caliper by finding the distance between the bony prominences (e.g. condyles) of each joint. Lastly, measure the height and weight of the participant using a standard tape measure and scale, respectively.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>In order to assess gait patterns (e.g. spatial-temporal measures) and postural alignment over a long period of time, use an accelerometry system for data collection during the 6 Minute Walk Test (6MWT), which is a valid and appropriate test in the assessment of older adult physical endurance13.
	<ol>
		<li>For the accelerometry system, ensure that it is comprised of at least 6 sensors, each with accelerometers and gyroscopes incorporated into them in order to measure both the acceleration (g) and angular velocity (deg/sec) of each specific body segment.
		<ol>
			<li>Prior to placement on the participant, ensure that all sensors are securely docked to the system&#39;s docking station in order to synchronize them and calibrate the system, and ultimately relay precise data measurements14.</li>
		</ol>
		</li>
		<li>Attach the sensors using adjustable hook and loop straps, secure the sensors to the wrists, ankles, lumbar spine (L5) and trunk and collect at a sampling rate of a minimum of 100 Hz.
		<ol>
			<li>When placing the sensors, ensure that they are oriented according to the system guidelines. Position the ankle sensors anteriorly. Position the wrist sensors posteriorly (when in anatomical position). Position the trunk sensor atop the sternum, and position the L5 sensor directly at the L5 vertebrae. 
			NOTE: Kinematic data is wirelessly transmitted from these sensors to an access point, which is used to precisely time the transmission of the synchronized data.</li>
		</ol>
		</li>
		<li>Fit the participant with the 6 sensors and ask them to perform two trials of the 6MWT, one with poles and one without. Randomly assign these two trials to control for order effect.</li>
		<li>Instruct the participant to walk back and forth along a 25 m walkway at a self-selected speed for the 6MWT, for both with and without poles. At this time, be sure to click &#39;Start&#39; to begin data collection with the accelerometry system. 
		NOTE: During pole trials, provide further instruction to the participant to implement their poling instruction.</li>
	</ol>
	</li>
	<li>Finally, assess short duration gait events using a 3-dimensional motion capture system collecting at a minimum of 100 Hz, with two force plates embedded in the pathway. Synchronize the force platforms with the motion capture system, ensure that the force platforms are zeroed to prevent noise in the data, and ensure that they are collecting at a sufficient sampling rate, for example 1,000 Hz.
	<ol>
		<li>Synchronize the force plates to the motion capture system by first connecting them to the computer via the wires provided from the company. Second, directly within the motion capture system software, it is imperative to &#39;add&#39; the force plates to the capture volume by entering the dimensions, sensitivities, sampling rates, and any other required information for the system.</li>
		<li>Ensure that the force plates have been &#39;zeroed&#39;. Do this in two steps: 1) right click on each force plate within the software and select &#39;Zero force plate&#39; and 2) press the &#39;zero&#39; button that is directly on the data acquisition box of the force plates. 
		NOTE: Ensure that the motion capture system collects real-time information from both the left and right legs from foot strikes on each force platform and allows for spatial-temporal, kinematic, and kinetic analysis.</li>
	</ol>
	</li>
	<li>Complete a dynamic calibration of the system (aimed at defining the capture volume that is to be used during data collection). To do this, wave a 3-marker wand in a controlled manner through the capture space. Then perform a static calibration of the system to set the global coordinate system (i.e. reference point of 0, 0, 0 (x, y, z) by placing a 4-marker L-frame at that specified reference point and select &#39;Set Volume&#39; within the computer software. 
	NOTE: The dynamic calibration later assists in the reconstruction of the 3-dimensional position of 39 reflective markers used for this model.
	<ol>
		<li>Fit the participant with the 39 reflective markers, attaching them using double-sided tape and placing them on specific anatomical landmarks including: second metatarsals, lateral malleoli, calcanei, left and right mid-shank, lateral femoral condyles, left and right mid-thigh, ASIS, PSIS, T10, C7, right back, clavicle, sternum, acromion processes, left and right mid-humerus, lateral epicondyles, left and right mid-forearm, medial and lateral wrists, second metacarpals, anterior-lateral head, and posterior-lateral head.</li>
		<li>Instruct the participant to then perform 6 trials of a 5 m walk through the systems capture volume, three with poles and three without. Randomly assign these trials to control for order effect and provide the same instruction as per the 6MWT.</li>
	</ol>
	</li>
</ol>
4. Data and Statistical Analysis14
<ol>
	<li>During analysis of the 6MWT, remove all turns during the trial in order to account for strictly steady state walking After removing the turns, use the system software to extract the spatial-temporal measures, trunk range of motion (ROM) in all places, and trunk velocities in all planes. 
	NOTE: This is done automatically during this protocol through algorithms used by the system itself14. The steps to extract the necessary dependent variables within this system are listed below.
	<ol>
		<li>Using the accelerometry system software, first click on &#39;Monitor Data&#39;, select the appropriate time stamped trials that have been collected, right click on the trials, and select &#39;Convert to CSV&#39;. After doing this, open the CSV file and ensure that data from all 6 sensors has been exported for further analysis.</li>
		<li>Next, select the trial again and click &#39;Export to PDF&#39;. Observe the system generate a PDF report with a number of variables. From here, extract variables that are desired for the study, in this case, spatial-temporal and kinematic measures.</li>
	</ol>
	</li>
	<li>For 3-dimensional motion capture, filter all trials using a fourth-order zero lag Butterworth filter for analog devices with a cut-off frequency of 10 Hz as well as a Woltring filter for the marker trajectories with a 15 mm MSE predicted value. To do this, attach the &#39;Butterworth and Woltring&#39; filtering options to the operations pipeline within the system software, select the aforementioned cut-off frequencies and MSE values, and click &#39;Run&#39;.
	<ol>
		<li>Add an &#39;Export to ASCII file&#39; operation to the operations pipeline within the system and select &#39;Run&#39;. Save the newly exported ASCII (spreadsheet) worksheet to the computer.</li>
		<li>Open the exported ASCII files and within each file, locate the power outputs and moments of force (i.e. kinetics) for each of the lower extremity joints, including the ankle, knee, and hip. 
		NOTE: Using the minimum and maximum functions within the worksheet, calculate the upper and lower peaks corresponding to the different phases of a single gait cycle (e.g. A1, K1, H1, etc.) as outlined by Winter14.</li>
		<li>Next, extract the spatial-temporal measures using the specific system software, which in this instance, is automatically calculated through system algorithms and from anthropometric measurements. To extract the specific variables, first import the desired trial into the system software, select &#39;Events&#39;, and click on the desired variable to obtain the variable average from each trial.</li>
	</ol>
	</li>
	<li>Lastly, using the ASCII files, locate the trajectories for the C7 marker as well as the sacral/pelvic markers. Using these trajectories, calculate postural alignment as the differential between these markers and trajectories in both the medial-lateral and anterior-posterior directions.</li>
	<li>Open statistical software and import the specific trial. First, using Shapiro-Wilks test for normality, ensure whether data is normally distributed.
	<ol>
		<li>To compare with and without poles, use paired t-tests when data is normally distributed and Wilcoxon Signed Rank Tests when skewed. Use Holm-Sidak multiple pairwise comparison procedures when necessary. Significance level is set at p &#60;0.05.</li>
	</ol>
	</li>
</ol>

<ol>
	<li>Parkatti, T., Wacker, P., Perttunen, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improvements+in+Functional+Capacity+from+Nordic+Walking:+A+Aandomized+Controlled+Trial+Among+Older+Adults.">Improvements in Functional Capacity from Nordic Walking: A Aandomized Controlled Trial Among Older Adults.</a> J Aging Phys Act. 20 (1), 93-105 (2012).</li><li>Schwameder, H., Roithner, R., Muller, E., Niessen, W., Raschner, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Knee+joint+forces+during+downhill+walking+with+hiking+poles.">Knee joint forces during downhill walking with hiking poles.</a> J Sports Sci. 17 (12), 969-978 (1999).</li><li>Willson, J., Torry, M. R., Decker, M. J., Kernozek, T., Steadman, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+walking+poles+on+lower+extremity+gait+mechanics.">Effects of walking poles on lower extremity gait mechanics.</a> Med Sci Sports Exerc. 33 (1), 142-147 (2001).</li><li>Koizumi, T., Tsujiuchi, N., Takeda, M., Fujikura, R., Kojima, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Load+dynamics+of+joints+in+Nordic+walking.">Load dynamics of joints in Nordic walking.</a> Procedia Engineering. 13, 544-551 (2011).</li><li>Hansen, L., Henriksen, M., Larsen, P., Alkjaer, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nordic+Walking+does+not+reduce+the+loading+of+the+knee+joint.">Nordic Walking does not reduce the loading of the knee joint.</a> Scand J Med Sci Spor. 18 (4), 436-441 (2008).</li><li>Stief, F., Kleindienst, F. I., Wiemeyer, J., Wedel, F., Campe, S., Krabbe, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inverse+dynamic+analysis+of+the+lower+extremities+during+Nordic+walking,+walking,+and+running.">Inverse dynamic analysis of the lower extremities during Nordic walking, walking, and running.</a> J Appl Biomech. 24 (4), 351-359 (2008).</li><li>Hagen, M., Hennig, E. M., Stieldorf, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lower+and+upper+extremity+loading+in+nordic+walking+in+comparison+with+walking+and+running.">Lower and upper extremity loading in nordic walking in comparison with walking and running.</a> J Appl Biomech. 27 (1), 22-31 (2011).</li><li>Shim, J., Kwon, H., Kim, H., Kim, B., Jung, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+the+effects+of+walking+with+and+without+Nordic+pole+on+upper+extremity+and+lower+extremity+muscle+activation.">Comparison of the effects of walking with and without Nordic pole on upper extremity and lower extremity muscle activation.</a> J Phys Ther Sci. 25 (12), 1553-1556 (2013).</li><li>Jensen, S. B., Henriksen, M., Aaboe, J., Hansen, L., Simonsen, E. B., Alkjaer, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+it+possible+to+reduce+the+knee+joint+compression+force+during+level+walking+with+hiking+poles.">Is it possible to reduce the knee joint compression force during level walking with hiking poles.</a> Scand J Med Sci Spor. 21 (6), 195-200 (2011).</li><li>Ashburn, A., Hyndman, D., Pickering, R., Yardley, L., Harris, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predicting+people+with+stroke+at+risk+of+falls.">Predicting people with stroke at risk of falls.</a> Age Ageing. 37 (3), 270-276 (2008).</li><li>Nasreddine, Z. S., Phillips, N. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Montreal+Cognitive+Assessment,+MoCA:+a+brief+screening+tool+for+mild+cognitive+impairment.">The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.</a> J Am Geriatr Soc. 53 (4), 695-699 (2005).</li><li>Teaching the Technique. Nordixx Inc Available from: <a target="_blank" href="https://www.nordixx.com/pages/teaching-the-technique/">https://www.nordixx.com/pages/teaching-the-technique/</a> (2015)</li><li>Rikli, R. E., Jones, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+reliability+and+validity+of+a+6-minute+walk+test+as+a+measure+of+physical+endurance+in+older+adults.">The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults.</a> J Aging Phys Activ. 6 (4), 363-375 (1998).</li><li>Winter, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomechanics+and+motor+control+of+human+gait:+normal,+elderly+and+pathological.">Biomechanics and motor control of human gait: normal, elderly and pathological.</a> ISBN. , (1991).</li><li>Winter, D. A., Patla, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Signal+processing+and+linear+systems+for+the+movement+sciences.">Signal processing and linear systems for the movement sciences.</a> Waterloo Biomechanics. , (1997).</li><li>Ali, N., Rouhi, G., Robertson, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gender,+vertical+height+and+horizontal+distance+effects+on+single-leg+landing+kinematics:+implications+for+risk+of+non-contact+acl+injury.">Gender, vertical height and horizontal distance effects on single-leg landing kinematics: implications for risk of non-contact acl injury.</a> J Hum Kinet. 37 (1), 27-38 (2013).</li></ol>

This work is funded in part by Nordixx Canada, makers of the walking poles used in this video.

The importance of maintaining consistency in terms of pole use is critical within this protocol. Particularly, appropriate steps for proper poling technique as well as proper pole set up are important to maintain consistency across different studies. Therefore the guidelines and instructions of a specific Nordic walking organization should be adhered to for protocols such as this. Additionally and particularly when using accelerometry, use of a full body set of tri-axial monitors is important to obtain a complete underst...

Nordic walking (NW) is regarded as a simple and safe form of fitness walking using specially designed poles1. It is suggested that poles provide added stability, improve posture, and reduce joint stress of the lower extremities. However, limited or contradictory evidence exists regarding joint loading and postural alignment. On one hand, Schwameder et al.2, Willson et al.3, and Koizumi et al.4 report improvements in kinematic measures and/or reductions in ground reaction, compression, and shear forces with their pole walking studies. On the other hand, declining kinematic measures and increased joint loading in terms of braking/propulsive forces and moments of force have been reported by Hansen et al.5, Stief et al.6, and Hagen et al.7 while pole walking. Additionally, claims of improved postural alignment appear to have gone entirely unsupported by scientific research to this point.
Similar to the contradictory results found with gait patterns, different methods and equipment have been employed in this line of research as well. Several studies have used 3-dimensional motion capture systems4,6 and digital video cameras2,5, all with force plates incorporated into the system, in order to adequately assess gait. While additionally, other studies have employed other means of assessing Nordic poling gait including use of electrogoniometry7, electromyography (EMG)8, and strain gauges mounted to poles2,9. With the technique utilized in this protocol, it presents the specific advantage of being able to demonstrate a more appropriate representation (i.e. repeated gait cycles) of an individual&#39;s Nordic poling gait over alternative techniques that have focused more on short durations and single gait cycles. Also, this method uses accelerometry, a valid tool, which to this point has been sparsely used in Nordic walking research. Depending on the aim of individual research projects, the application of this protocol may be appropriate for situations as outlined in this protocol, particularly for short and long duration gait. It is important to note that both motion capture and accelerometry are suitable for obtaining a variety of gait characteristics including: spatial-temporal (e.g. stride length, gait speed, etc.), kinematic (e.g. range of motion), and kinetic (e.g. forces, power outputs, etc.) parameters.
And despite the use of these various pieces of equipment, only short duration gait events (i.e. single gait cycle) have been assessed, leaving questions in regards to best assessing longer duration gait (i.e. repeated gait cycles). Therefore, the rationale for the development and use of this technique is based upon the importance of fashioning a complete picture of Nordic poling gait.
The purpose of this study was two-fold. First, the primary goal is to determine and substantiate the use of both accelerometry systems and 3-dimensional motion capture systems in the assessment of gait and posture over both short and long durations. Secondarily, the goal is to determine the overall effect of Nordic walking poles on gait patterns including spatial-temporal and kinetic measures as well as postural alignment of older adults. To date, minimal research has focused on older adult NW and of that which has been published, function (i.e. strength, balance, flexibility) has represented the primary outcome variables. Therefore, knowledge pertaining the role of walking poles on measureable gait variables is needed and can provide insight into how poles can play into our gait patterns as we age.

<table>
	<tbody>
		<tr>
			<td>Nordic walking poles</td>
			<td>Nordixx Canada</td>
			<td>Nordixx Global Traveler or Walker</td>
			<td>Alternative poles may be used</td>
		</tr>
		<tr>
			<td>APDM accelerometry system</td>
			<td>APDM</td>
			<td>Opal system</td>
			<td>Alternative systems may be used</td>
		</tr>
		<tr>
			<td>Vicon motion capture system</td>
			<td>Vicon</td>
			<td></td>
			<td>Alternative systems may be used</td>
		</tr>
		<tr>
			<td>Kistler force platforms</td>
			<td>Kistler</td>
			<td></td>
			<td>Alternative platforms may be used</td>
		</tr>
		<tr>
			<td>Vicon Nexus &#38; Polygon</td>
			<td>Vicon</td>
			<td></td>
			<td>Used in data analysis</td>
		</tr>
		<tr>
			<td>14mm reflective markers</td>
			<td>Vicon</td>
			<td></td>
			<td>Number or markers depends on model</td>
		</tr>
		<tr>
			<td>Tape measure</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Weight scale</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Caliper</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

substantiating appropriate motion capture techniques for the assessment of nordic walking gait and posture in older adults

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques have been employed, each with positives and negatives. The aim was to determine the effect of NW on older adult gait and posture and to determine optimal use of different data collection systems in both short and long duration analysis. Gait and posture during NW and normal walking were assessed in 17 healthy older adults (age: 69 &#177; 7.3). Participants performed two trials of 6 Minute Walk Tests (6MWT) (1 with poles (WP) and 1 without poles (NP)) and 6 trials of a 5m walk (3 WP and 3 NP). Motion was recorded using two systems, a 6-sensor accelerometry system and an 8-camera 3-dimensional motion capture system, in order to quantify spatial-temporal, kinematic, and kinetic parameters.
With both systems, participants demonstrated increased stride length and double support and decreased gait speed and cadence WP compared to NP (p &#60;0.05). Also, with motion capture, larger single support time was found WP (p &#60;0.05). With 3-D capture, smaller hip power generation and moments of force were found at heel contact and pre-swing as well as smaller knee power absorption at heel contact, pre-swing, and terminal swing WP compared to NP, when assessed over one cycle (p &#60;0.05). Also, WP yielded smaller moments of force at heel contact and terminal swing along with larger moments at mid-stance of a gait cycle (p &#60;0.05). No changes were found for posture.
NW seems appropriate for promoting a normal gait pattern in older adults. Three-dimensional motion capture should primarily be used during short duration gait analysis (i.e. single gait cycle), while accelerometry systems should be primarily employed in instances requiring longer duration analysis such as during the 6MWT.

Spatial-Temporal Gait Parameters
When walking with Nordic walking poles and assessed using motion capture and force plates, stride length (p &#60;0.01), double support time (p &#60;0.001), and single support time (p &#60;0.001) are all significantly longer compared to walking without poles. In addition, gait speed (p &#60;0.05) is significantly slower and cadence (p &#60;0.001) is significantly smaller with poles compared to wit...

Watch this Scientific Journal Video about Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults at JoVE.com

Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques ...

substantiating-appropriate-motion-capture-techniques-for-assessment

Universidad San Sebastian

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JoVE Journal

Behavior

8.7K Views.  University of Ottawa. The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

Video: Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple step elements. Adapted tango involves movement initiation and cessation, multi-directional perturbations, varied speeds and rhythms. Focus on foot placement, whole body coordination, and attention to partner, path of movement, and aesthetics likely underlie adapted tango&#8217;s demonstrated efficacy for improving mobility and balance. In this paper, we describe the methodology to disseminate the adapted tango teaching methods to dance instructor trainees and to implement the adapted tango by the trainees in the community for older adults and individuals with Parkinson&#8217;s Disease (PD). Efficacy in improving mobility (measured with the Timed Up and Go, Tandem stance, Berg Balance Scale, Gait Speed and 30 sec chair stand), safety and fidelity of the program is maximized through targeted instructor and volunteer training and a structured detailed syllabus outlining class practices and progression.

Adapted tango has demonstrated efficacy for improving mobility and balance. We describe the dissemination of adapted tango teaching methods to dance instructor trainees and the implementation of adapted tango by the trainees in the community for improving mobility and balance in older adults and individuals with Parkinson&#8217;s disease.

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple ...

Measuring Attentional Biases for Threat in Children and Adults

Investigators have long been interested in the human propensity for the rapid detection of threatening stimuli. However, until recently, research in this domain has focused almost exclusively on adult participants, completely ignoring the topic of threat detection over the course of development. One of the biggest reasons for the lack of developmental work in this area is likely the absence of a reliable paradigm that can measure perceptual biases for threat in children. To address this issue, we recently designed a modified visual search paradigm similar to the standard adult paradigm that is appropriate for studying threat detection in preschool-aged participants. Here we describe this new procedure. In the general paradigm, we present participants with matrices of color photographs, and ask them to find and touch a target on the screen. Latency to touch the target is recorded. Using a touch-screen monitor makes the procedure simple and easy, allowing us to collect data in participants ranging from 3 years of age to adults. Thus far, the paradigm has consistently shown that both adults and children detect threatening stimuli (e.g., snakes, spiders, angry/fearful faces) more quickly than neutral stimuli (e.g., flowers, mushrooms, happy/neutral faces). Altogether, this procedure provides an important new tool for researchers interested in studying the development of attentional biases for threat.

Here we describe a touch-screen visual search paradigm that can be used to study threat detection across the lifespan. The paradigm has already been used in various studies demonstrating that both children and adults detect threatening stimuli like snakes, spiders, and angry faces faster than non-threatening stimuli.

Investigators have long been interested in the human propensity for the rapid detection of threatening stimuli. However, until recently, research in this ...

Multifunctional Setup for Studying Human Motor Control Using Transcranial Magnetic Stimulation, Electromyography, Motion Capture, and Virtual Reality

The study of neuromuscular control of movement in humans is accomplished with numerous technologies. Non-invasive methods for investigating neuromuscular function include transcranial magnetic stimulation, electromyography, and three-dimensional motion capture. The advent of readily available and cost-effective virtual reality solutions has expanded the capabilities of researchers in recreating &#8220;real-world&#8221; environments and movements in a laboratory setting. Naturalistic movement analysis will not only garner a greater understanding of motor control in healthy individuals, but also permit the design of experiments and rehabilitation strategies that target specific motor impairments (e.g. stroke). The combined use of these tools will lead to increasingly deeper understanding of neural mechanisms of motor control. A key requirement when combining these data acquisition systems is fine temporal correspondence between the various data streams. This protocol describes a multifunctional system&#8217;s overall connectivity, intersystem signaling, and the temporal synchronization of recorded data. Synchronization of the component systems is primarily accomplished through the use of a customizable circuit, readily made with off the shelf components and minimal electronics assembly skills.

Transcranial magnetic stimulation, electromyography, and 3D motion capture are commonly used non-invasive techniques for investigating neuromuscular function in humans. In this paper, we describe a protocol that synchronously samples data generated by all three of these tools along with the unique addition of virtual reality stimulus presentation and feedback.

The study of neuromuscular control of movement in humans is accomplished with numerous technologies. Non-invasive methods for investigating neuromuscular ...

Visualizing Motion Patterns in Acupuncture Manipulation

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture manipulation techniques skillfully. The Acupuncture Manipulation Education System (AMES) is an open source software system designed to enhance acupuncture manipulation skills using visual feedback. Using a phantom acupoint and motion sensor, our method for acupuncture manipulation training provides visual feedback regarding the actual movement of the student's acupuncture manipulation in addition to the optimal or intended movement, regardless of whether the manipulation skill is lifting, thrusting, or rotating. Our results show that students could enhance their manipulation skills by training using this method. This video shows the process of manufacturing phantom acupoints and discusses several issues that may require the attention of individuals interested in creating phantom acupoints or operating this system.

Here, we present a protocol for using the Acupuncture Manipulation Education System (AMES) in the training of acupuncture manipulation skills using phantom acupoints.

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture ...

Reversible Cooling-induced Deactivations to Study Cortical Contributions to Obstacle Memory in the Walking Cat

On complex, naturalistic terrain, sensory information about an environmental obstacle can be used to rapidly adjust locomotor movements for avoidance. For example, in the cat, visual information about an impending obstacle can modulate stepping for avoidance. Locomotor adaptation can also occur independent of vision, as sudden tactile inputs to the leg by an expected obstacle can modify the stepping of all four legs for avoidance. Such complex locomotor coordination involves supraspinal structures, such as the parietal cortex. This protocol describes the use of reversible, cooling-induced cortical deactivation to assess parietal cortex contributions to memory-guided obstacle locomotion in the cat. Small cooling loops, known as cryoloops, are specially shaped to deactivate discrete regions of interest to assess their contributions to an overt behavior. Such methods have been used to elucidate the role of parietal area 5 in memory-guided obstacle avoidance in the cat.

Complex locomotion in naturalistic environments requiring careful coordination of the limbs involves regions of the parietal cortex. The following protocol describes the use of reversible cooling-induced deactivation to demonstrate the role of parietal area 5 in memory-guided obstacle avoidance in the walking cat.

On complex, naturalistic terrain, sensory information about an environmental obstacle can be used to rapidly adjust locomotor movements for avoidance. For ...

Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder

Three-dimensional gait analysis (3DGA) is shown to be a useful clinical tool for the evaluation of gait abnormality due to movement disorders. However, the use of 3DGA in actual clinics remains uncommon. Possible reasons could include the time-consuming measurement process and difficulties in understanding measurement results, which are often presented using a large number of graphs. Here we present a clinician-friendly 3DGA method developed to facilitate the clinical use of 3DGA. This method consists of simplified preparation and measurement processes that can be performed in a short time period in clinical settings and intuitive results presentation to facilitate clinicians&#39; understanding of results. The quick, simplified measurement procedure is achieved by the use of minimum markers and measurement of patients on a treadmill. To facilitate clinician understanding, results are presented in figures based on the clinicians&#39; perspective. A Lissajous overview picture (LOP), which shows the trajectories of all markers from a holistic viewpoint, is used to facilitate intuitive understanding of gait patterns. Abnormal gait pattern indices, which are based on clinicians&#39; perspectives in gait evaluation and standardized using the data of healthy subjects, are used to evaluate the extent of typical abnormal gait patterns in stroke patients. A graph depicting the analysis of the toe clearance strategy, which depicts how patients rely on normal and compensatory strategies to achieve toe clearance, is also presented. These methods could facilitate implementation of 3DGA in clinical settings and further encourage development of measurement strategies from the clinician&#39;s point of view.

In this study, a clinician-friendly three-dimensional gait analysis method, which was designed to be performed in the rehabilitation clinic, is presented. The method consists of a simplified measurement method and intuitive figures to facilitate clinicians&#39; understanding of the results.

Three-dimensional gait analysis (3DGA) is shown to be a useful clinical tool for the evaluation of gait abnormality due to movement disorders. However, ...

Measuring the Kinematics of Daily Living Movements with Motion Capture Systems in Virtual Reality

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based assessments of IADL are easy to use but prone to subjective bias. Here, we describe a novel virtual reality (VR) test to assess two complex IADL tasks: handling financial transactions and using public transportation. While a participant performs the tasks in a VR setting, a motion capture system traces the position and orientation of the dominant hand and head in a three-dimensional Cartesian coordinate system. Kinematic raw data are collected and converted into &#39;kinematic performance measures,&#39; i.e., motion trajectory, moving distance, and time to completion. Motion trajectory is the path of a particular body part (e.g., dominant hand or head) in space. Moving distance refers to the total distance of the trajectory, and time to completion is how long it took to complete an IADL task. These kinematic measures could discriminate patients with cognitive impairment from healthy controls. The development of this kinematic measuring protocol allows detection of early IADL-related cognitive impairments.

We designed a virtual reality test to assess instrumental activities of daily living (IADL) with a motion capture system. We propose a detailed kinematic analysis to interpret the participant&#39;s various movements, including trajectory, moving distance, and time to completion to evaluate IADL capabilities.

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based ...

Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS&#39;s are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.

This paper discusses the use of a continuous and objective real-time locating system to measure walking activity associated with wandering behaviors, focusing on older adults with cognitive impairment. Walking activity is measured by walking distance, sustained walking distance, and sustained gait speed. Also assessed are gait quality and balance ability.

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for ...

3D Kinematic Gait Analysis for Preclinical Studies in Rodents

The utility of three-dimensional (3D) kinematic motion analysis systems is limited in rodents. Part of the reason for this inadequacy is the use of complex algorithms and mathematical modeling that accompany 3D data collection and analysis procedures. This work provides a simple, user-friendly, step-by-step detailed methodology for 3D kinematic gait analysis during treadmill locomotion in healthy and neurotraumatic rats using a six-camera motion capture system. Also provided are details on 1) calibration of the system in an experimental set-up customized for quadrupedal locomotion, 2) data collection for treadmill locomotion in adult rats using markers positioned on all four limbs, 3) options available for video tracking and processing, and 4) basic 3D kinematic data generation and visualization and quantification of data using the built-in data collection software. Finally, it is suggested that the utility of this motion capture system be expanded to studying a variety of motor behaviors before and after neurotrauma.

Presented here is a protocol to collect and analyze three-dimensional kinematics of quadrupedal locomotion in rodents for preclinical studies.

The utility of three-dimensional (3D) kinematic motion analysis systems is limited in rodents. Part of the reason for this inadequacy is the use of ...

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological cognitive decline. It is thus essential that cognitive tests and their administration are as fair as possible. However, an important source of bias during cognitive testing comes from negative aging stereotypes that can impair the memory performance of older adults and inflate age differences on cognitive tasks. The fear of confirming negative aging stereotypes creates an extra pressure among older adults which interferes with their intellectual functioning and leads them to perform below their true abilities. Here, we present a protocol that highlights simple but efficient interventions to alleviate this age-based stereotype threat effect. The first study showed that simply informing older participants about the presence of younger participants (threat condition) led older adults to underperform on a standardized memory test compared with younger participants, and that this performance difference was eliminated when the test was presented as age-fair (reduced-threat condition). The second study replicated these findings on short cognitive tests used to screen for predementia in clinical settings and showed that teaching older adults about stereotype threat inoculated them against its effects. These results provide useful recommendations about how to improve older adults' memory assessment both in Iab studies and in clinical settings.

Here, we present a protocol designed to show how negative aging stereotypes can impair memory performance of older adults during cognitive testing and how to reduce this deleterious effect. This method can help older people to perform at an optimal level during testing in both lab studies and clinical settings.

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological ...