Name: substantiating appropriate motion capture techniques for the assessment of nordic walking gait and posture in older adults
Uploaded: 2016-05-12T15:00:00
Description: 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 ...

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.</e...

<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>

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...

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.

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 ...

The overall goal of this experiment is to determine the effects that Nordic Walking Poles have on both gait patterns and postural alignment, specifically in older adults. This method can help answer key questions in the field of biomechanics, such as how can arctic walking be used to aid in improving gait and posture in older adults. And what are optimum methods of assessing such gait and postural variables.The main advantage of this technique is that it demonstrates two efficient methods for assessing gait and posture as they pertain to Nordic Walking. The implication of this technique may extend towards therapy settings. Specifically As a use of Nordic poles, may aid with various gait and conditions.Demonstrating this procedure will be Zach Bonsegen, one of my graduate students. To begin, provide each participant with a set of poles and instruct them to stand tall. Then, have the participant place the poles'tips in front of their toes and place their elbows next to their body.Instruct the participants to lengthen the poles until their elbows form an approximate 90 degree angle next to the body, ensure the adjustment corresponds to approximately 65%of the participant's body height. Then, securely tighten the poles and angle the boot tips backwards. Before securing the wrist straps, instruct the participant in correct body posture by having them place their poles behind the lower back, and stand tall.Also ask the participants to stand with their chest tall and the shoulders relaxed. Then, have each participant secure their wrist straps, place the pole tips behind them, and relax their arms at their sides. While keeping their hands open, instruct the subject to begin walking with minimal arm swings for approximately 100 meters.While still keeping the hands open, and dragging the poles behind them, instruct the participant to begin walking faster and with larger arm movements. Then, ask the participants to visualize bringing their hand up, as if they are about to shake someone's hand. 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. The tip of the pole should be aligned with the foot midline. Learning and understanding the technique is critical to ensure consistency with this protocol.To ensure this to happen, we've broken the instructions into four succinct statements to simplify things, and ensure optimal performance from all participants. Begin data collection by collecting each participant's anthropometric measurements. Start by using a tape measure to measure each leg's length as the distance from the anterior superior iliac spine to the center of the medial malleolus.Then, measure the distance between the left and right osseous, known as the interosseous distance, as well as the shoulder offsets. Using calipers, measure the widths of each joint, by finding the distance between the bony prominences of each joint. Do this to measure their knee widths, ankle widths, elbow widths, wrist widths and also measure hand thicknesses.Lastly, use the standard weight scale to measure the participant's weight and the tape measure to measure the participant's height. In order to assess gait patterns and postural alignment over a long period of time, use an accelerometry system for data collection during the six-minute walk test. Ensure that the accelerometry system is comprised of at least six sensors, each with accelerometers and gyroscopes incorporated into them, in order to measure both the acceleration and angular velocity of each specific body segment.Prior to their placement on the participant, ensure that all of the sensors are securely docked to the system's docking station, in order to synchronize them and calibrate the system. Next, use adjustable hook and loop straps to attach the senors to the wrists posteriorly, to the ankle anteriorly, to the L5 vertebrae of the lumbar spine and to the trunk atop the sternum. Set the sampling rate to a minimum of 100 Hertz.Then, ask the participant to perform two trials of the six-minute walk test, one with poles and one without. Randomly assign the two trials to control for order effect. Instruct the participant to walk back and forth along the 25 meter walkway at a self-selected speed for six minutes.Before the participant begins, be sure to click start to begin data collection with the accelerometry system. When both trials of the six-minute walk test have been completed, assess short-duration gait events using a three-dimensional motion capture system with two force plates embedded in the pathway. Synchronize the force plates to the motion capture system by first connecting them to the computer via the wires provided from the company.Then, in the motion capture system software, add the force plates to the capture volume by entering the dimensions, position, orientation, sensitivities and any other required information for the system. Ensure that the force platforms are zeroed to prevent noise in the data, and ensure they are collecting at a sufficient sampling rate of 1, 000 Hertz. Next, complete a dynamic calibration of the system by first waving a 3-marker wand in a controlled manner through the capture space.Then, perform a static calibration to set the global xyz coordinate system by placing a four marker L-frame at that specified reference point and select set volume within the computer software. Calibration of the motion capture system is critical to ensure accuracy of collected data and is done before all else. To ensure accurate results, the image error is assessed and, if necessary, calibrations are repeated until optimal values are obtained.With the software calibrated, fit the participant with the 39 reflective markers, attaching them using double-sided tape, and placing them on the specific anatomical landmarks shown here and described in the accompanying text protocol. Finally, instruct the participant to perform six trials of a 5 meter walk, through the system's capture volume, three with poles and three without. Randomly assign these trials to control for order effect.This graph represents a typical hip power profile over one single gait cycle and compares a participant's gait with poles to the gait without poles. The arrows at H1, H2 and H3 indicate the changes in power generation and absorption in comparing these phases with and without poles. When using poles, significantly smaller hip power generation is seen at heel contact as well as at pre-swing and initial swing, compared to walking without poles.Shown here is a typical knee power profile over one single gait cycle comparing with poles to without poles. When using poles, significantly smaller knee power absorption is seen at heel contact, at pre-swing and at terminal swing compared to walking without poles. Once mastered, this technique can be done in 45 to 60 minutes per participant, if it's performed properly.While performing the procedure, it's important to ensure that the participants walk naturally both with and without the poles. Therefore, they should not be made aware of where the force plates are. Following this procedure, other methods like EMG can be performed in order to answer additional questions such as activation patterns of the muscles, especially muscles of the upper body.After watching this video, you should have a good understanding of how to assess Nordic Walking gait and posture, using at least one of the two different motion capture systems. This protocol allows researchers in the field of biomechanics to explore the effect of Nordic Walking on gait and posture in older adults but also in other populations with gait and posture disorders such as individual with Parkinson's disease. Don't forget that introducing a new implement, such as the poles, could increase the level of attention needed to perform the motor task, and therefore, participants should be made aware to start training in a safe environment.

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