The protocol follows the guidelines of the local human Ethics Committee in Zurich (KEK Zurich).
1. Hardware Installation (Figure 1)
<ol>
	<li>Use two 10-m sets of floor-based bars and place them parallel to each other (and to the line of progression) to create a corridor with an inter-set distance of approximately 1 m. 
	NOTE: This distance can be increased up to 8 m. Each bar has a length of 1 m&#160;and consists of 96 light diodes.</li>
	<li>Make a distinction between light-transmitting (T) and light-receiving (R) units for the installation of the bars by placing the light-transmitting (T) units on the right side and the light-receiving (R) units on the left side with respect to the walking direction. 
	NOTE: The first meter bars (both T and R) have silver drums. The T and R bars disposed on the remaining 9 m&#160;are all equal and interchangeable.</li>
	<li>Connect all bars of a row with caps (wireless). Use 2&#160;power supplies: one for each set of bars (T and R).</li>
	<li>Connect the first R bar to the laptop with a USB cable.</li>
	<li>Position the camera next to the first bar for offline verifications (e.g., starting foot), and connect it to the laptop with a USB cable.</li>
	<li>Put a mark 2 m before and after the beginning and end of the track.</li>
	<li>Switch on the photoelectric device using the on-off switch of the first R and T bar.</li>
	<li>Check that the control LEDs&#160;located on all R bars are green. 
	NOTE: If so, the system is correctly positioned and testing can start; however, if one or more of the control LEDs are red the system is not correctly positioned and/or connected. Control all caps by checking that they are completely clicked into place and then turn the system off and on again.</li>
</ol>
<img alt="Figure 1" src="/files/ftp_upload/51878/51878fig1.jpg" /> 
Figure 1.&#160;The photoelectric system consists of light-transmitting (T) and light-receiving (R) units that are placed parallel to each other with a distance of approximately 1 m. The camera is installed close to the start area for control purposes. The laptop is connected with USB cables to the first R bar and to the camera. <a href="https://www.jove.com/files/ftp_upload/51878/51878fig1highres.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
2. Software Installation and Preparation of a Test
<ol>
	<li>Load the software operating the photoelectric system from www.optogait.com/Support/Downloads. Note: This protocol is described by using the 1.8.1 version.</li>
	<li>If the software is used for the first time for gait analysis create a new test as follows (otherwise proceed to step 2.3):
	<ol>
		<li>Select Test then click on Define / Modify tests. Now&#160;click on Gait test and then select Duplicate test. Click on Confirm in the pop-up window so that the test is duplicated.</li>
		<li>Double click on the duplicated test to modify the name (e.g., Gait Test 10 bars) and select 10 for the number of bars. Use the standard parameters for the gait test, which are presented in Figure 2. Finally, select Save to save all modifications.</li>
	</ol>
	</li>
	<li>Add a new patient to the database. Select Patients, click on Insert / Modify patient, and then click on New patient to enter the data. Then Save the data.</li>
</ol>
<img alt="Figure 2" src="/files/ftp_upload/51878/51878fig2.jpg" /> 
Figure 2.&#160;Standard settings for a gait test with 10 bars, as described in the present protocol. These settings have to be defined when the photoelectric system is used for the first time. In this protocol the starting foot is not defined. The system starts measuring when the patient enters the recording area and stops measuring when the patient leaves the measuring units. <a href="https://www.jove.com/files/ftp_upload/51878/51878fig2highres.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
3. Testing Procedures
<ol>
	<li>Always give the same instructions to the patient13.
	<ol>
		<li>Instruct the patient to walk with flat-soled shoes along the 10-m walkway at two different velocities: normal (&#8220;walk at a pace that is comfortable for you&#8221;), and faster than normal (&#8220;walk at a pace that is faster than you would normally walk&#8221;).</li>
		<li>Ask the patient to look straight ahead during the walking trials.</li>
		<li>Ask the patient to initiate the first step with the same foot to better standardize the test conditions.</li>
		<li>Ask the patient to start walking 2 m&#160;before the first photoelectric bar and to conclude each trial 2 m&#160;after the last bar in order to maintain constant gait velocity13.</li>
	</ol>
	</li>
	<li>Demonstrate one trial at normal velocity to the patient.</li>
	<li>Request the patient to perform three familiarization trials followed by one experimental trial at each velocity. Always complete normal velocity trials first.</li>
	<li>To get ready with the software, click on Test and then Execute to start the measurements with the created test.
	<ol>
		<li>Select the patient by clicking on Select, choosing the patient and then clicking on Confirm.</li>
		<li>Select the test by clicking on Select, and choosing the test e.g., Gait Test 10 bars. Check that only this test is selected for the measurement.</li>
		<li>Place the camera&#160;so that it can record the entire walk. Change the position of the camera while checking the live picture on the screen of your laptop.</li>
		<li>Finally, click on Execute again. 
		NOTE: Now the software is ready to measure. As soon as the patient enters the bars, the system starts to measure and a pop-up window appears asking for the starting foot.</li>
	</ol>
	</li>
	<li>Click on the appropriate foot so that the gait parameters will be correctly calculated. 
	NOTE: The camera records automatically once the test is started.</li>
	<li>Save the test.</li>
</ol>
4. Data Analysis
<ol>
	<li>Click on Results to display the completed trials. Then click on the arrow next to the test of interest to transfer the test from the Test list to the Test analysis section. Now click on View to display the selected test. Refer to the Results section for all tests performed in this study. 
	NOTE: A window with all test data appears (Figure 3). On the left side of the window there are some command buttons for activating various functions. The other part of the window presents 4 types of information regarding the current test. Each set of information can be shown/hidden using the configuration commands. From top to bottom the items are the following: video, charts displaying the results, table with numerical data, and photoelectric bars.</li>
	<li>Click on Gait data to display a gait report (Figure 3).</li>
	<li>Click on Print (a window with the report appears) to print out the report. 
	NOTE: The report can be printed as it is or can be modified. For the different spatiotemporal parameters, the following results are presented in the report: mean values &#177; standard deviation (SD) of the left and right side, coefficients of variation (CV) expressing gait variability14,15, and percent difference between the left and the right side (asymmetry).
	<ol>
		<li>If required, modify the report as follows: open the report as described above (step 4.3). Click on the buttons Show or Hide on the left side of the screen to adapt the presented data and charts of the report.</li>
		<li>To change the logo and/or the footer on the report, click on the respective button (Change logo or Change footer) to modify these parameters.</li>
	</ol>
	</li>
	<li>To compare two or more tests performed on different occasions, e.g., before and after an intervention, select the different tests in the results section by clicking on the arrow next to the tests and then click on the Compare button. 
	NOTE: A report with the direct comparison of all parameters of the different tests is displayed.</li>
</ol>
<img alt="Figure 3" src="/files/ftp_upload/51878/51878fig3.jpg" /> 
Figure 3.&#160;Screenshot of all test data. The command buttons appear on the left side of the window (e.g., by clicking on Print a report is generated, which can be eventually modified). The other part of the window presents the following information regarding the current test, from top to bottom: video, charts displaying the results, table with numerical data, and photoelectric bars. These details can be shown/hidden using the Configure button on the right side. The actual view of the data can be changed by clicking on Gait data or Gait report, respectively. <a href="https://www.jove.com/files/ftp_upload/51878/51878fig3highres.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

<ol>
	<li>Chow, J. W., Yablon, S. A., Horn, T. S., Stokic, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temporospatial+characteristics+of+gait+in+patients+with+lower+limb+muscle+hypertonia+after+traumatic+brain+injury.">Temporospatial characteristics of gait in patients with lower limb muscle hypertonia after traumatic brain injury.</a> Brain. Inj. 24, 1575-1584 (2010).</li><li>Esser, P., Dawes, H., Collett, J., Feltham, M. G., Howells, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+spatio-temporal+gait+parameters+using+inertial+measurement+units+in+neurological+populations.">Assessment of spatio-temporal gait parameters using inertial measurement units in neurological populations.</a> Gait Posture. 34, 558-560 (2011).</li><li>Maffiuletti, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spatiotemporal+parameters+of+gait+after+total+hip+replacement:+anterior+versus+posterior+approach.">Spatiotemporal parameters of gait after total hip replacement: anterior versus posterior approach.</a> Orthop. Clin. North Am. 40, 407-415 (2009).</li><li>Webster, K. E., Wittwer, J. E., Feller, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+gait+analysis+after+medial+unicompartmental+knee+arthroplasty+for+osteoarthritis.">Quantitative gait analysis after medial unicompartmental knee arthroplasty for osteoarthritis.</a> J. Arthroplasty. 18, 751-759 (2003).</li><li>Chui, K. K., Lusardi, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spatial+and+temporal+parameters+of+self-selected+and+fast+walking+speeds+in+healthy+community-living+adults+aged+72-98+years.">Spatial and temporal parameters of self-selected and fast walking speeds in healthy community-living adults aged 72-98 years.</a> J. Geriatr. Phys. Ther. 33, 173-183 (2010).</li><li>Hollman, J. H., McDade, E. M., Petersen, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normative+spatiotemporal+gait+parameters+in+older+adults.">Normative spatiotemporal gait parameters in older adults.</a> Gait Posture. 34, 111-118 (2011).</li><li>Lienhard, K., Schneider, D., Maffiuletti, 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=Validity+of+the+Optogait+photoelectric+system+for+the+assessment+of+spatiotemporal+gait+parameters.">Validity of the Optogait photoelectric system for the assessment of spatiotemporal gait parameters.</a> Med. Eng. Phys. 35, 500-504 (2013).</li><li>Perry, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+analysis,+normal+and+pathological+function.">Gait analysis, normal and pathological function.</a> First edn, Slack Inc. , (1992).</li><li>Lee, M. M., Song, C. H., Lee, K. J., Jung, S. W., Shin, D. C., Shin, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concurrent+validity+and+test-retest+reliability+of+the+OPTOGait+photoelectric+cell+system+for+the+assessment+of+spatio-temporal+parameters+of+the+gait+of+young+adults.">Concurrent validity and test-retest reliability of the OPTOGait photoelectric cell system for the assessment of spatio-temporal parameters of the gait of young adults.</a> J. Phys. Ther. Sci. 26, 81-85 (2014).</li><li>Item-Glatthorn, J. F., Casartelli, N. C., Petrich-Munzinger, J., Munzinger, U. K., Maffiuletti, 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=Validity+of+the+intelligent+device+for+energy+expenditure+and+activity+accelerometry+system+for+quantitative+gait+analysis+in+patients+with+hip+osteoarthritis.">Validity of the intelligent device for energy expenditure and activity accelerometry system for quantitative gait analysis in patients with hip osteoarthritis.</a> Arch. Phys. Med. Rehabil. 93, 2090-2093 (2012).</li><li>Maffiuletti, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concurrent+validity+and+intrasession+reliability+of+the+IDEEA+accelerometry+system+for+the+quantification+of+spatiotemporal+gait+parameters.">Concurrent validity and intrasession reliability of the IDEEA accelerometry system for the quantification of spatiotemporal gait parameters.</a> Gait Posture. 27, 160-163 (2008).</li><li>Reed, L. F., Urry, S. R., Wearing, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+spatiotemporal+and+kinetic+gait+parameters+determined+by+a+new+instrumented+treadmill+system.">Reliability of spatiotemporal and kinetic gait parameters determined by a new instrumented treadmill system.</a> BMC Musculoskelet. Disord. 14, 249 (2013).</li><li>Kressig, R. W., Beauchet, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+clinical+applications+of+spatio-temporal+gait+analysis+in+older+adults.">Guidelines for clinical applications of spatio-temporal gait analysis in older adults.</a> Aging Clin. Exp. Res. 18, 174-176 (2006).</li><li>Dubost, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationships+between+dual-task+related+changes+in+stride+velocity+and+stride+time+variability+in+healthy+older+adults.">Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults.</a> Hum. Mov. Sci. 25, 372-382 (2006).</li><li>Hausdorff, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+variability:+methods,+modeling+and+meaning.">Gait variability: methods, modeling and meaning.</a> J. Neuroeng. Rehabil. 2, (2005).</li><li>Blin, O., Ferrandez, A. M., Serratrice, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+analysis+of+gait+in+Parkinson+patients:+increased+variability+of+stride+length.">Quantitative analysis of gait in Parkinson patients: increased variability of stride length.</a> J. Neurol. Sci. 98, 91-97 (1990).</li><li>Webster, K. E., Merory, J. R., Wittwer, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+variability+in+community+dwelling+adults+with+Alzheimer+disease.">Gait variability in community dwelling adults with Alzheimer disease.</a> Alzheimer. Dis. Assoc. Disord. 20, 37-40 (2006).</li><li>Bejek, Z., Paroczai, R., Illyes, A., Kiss, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+walking+speed+on+gait+parameters+in+healthy+people+and+in+patients+with+osteoarthritis.">The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis.</a> Knee Surg. Sports Traumatol. Arthrosc. 14, 612-622 (2006).</li></ol>

The authors have nothing to disclose.

The protocol presented here can be used to evaluate spatial and temporal gait parameters of patients (orthopedic, neurological, cardiorespiratory, etc.) and healthy older adults with a recently-introduced photoelectric system. The total length and width of the system can be modulated depending on the available space and budget. The estimated cost (in Europe) is approximately 2,800 USD per meter for a 10-meter&#160;system and the minimum recommended length is 3 meter&#160;for floor-based gait analysis. A new feature of th...

Walking is one of the most important physical activities in everyday life, and is a main determinant of the quality of life for elderly and patient populations who may present with gait deteriorations. Clinical evaluation of gait function is therefore important to reveal potential alterations induced by aging and/or neurological/orthopedic pathologies, but also to prove the functional benefits of a treatment. Different instruments have been developed for the quantitative assessment of gait parameters, e.g., force plates, video-based 3D motion analysis, body-mounted accelerometers10,11, and instrumented walkway mats or treadmills12. However, these systems are mainly used for research studies rather than for clinical purposes because they are complex to operate, have low accessibility, and fragile sensors.
A floor-based photoelectric system has recently been introduced, which is able to provide a valid calculation of temporal features and 1D spatial coordinates of walking steps. This measuring instrument has several advantages compared to pre-existing systems: it is easy to handle, data are collected very quickly, it is simple to create a detailed report and it is a modular system which means that the length of the system can be changed. Thus, it can be used with confidence to measure within-group changes in longitudinal assessments and between-group differences in cross-sectional comparisons. The goals of the described protocol are to focus on the equipment and its installation, and to objectively and straightforwardly describe the assessment procedures for evaluating spatiotemporal gait parameters in elderly and patient populations.

<table><tbody><tr><td>Optogait system (10 meters)</td><td>Microgate, Bolzano, Italy</td><td></td><td>&lt;a href=&quot;http://www.optogait.com/&quot;&gt;www.optogait.com&lt;/a&gt;</td></tr><tr><td>Optogait software</td><td></td><td></td><td>www.optogait.com/Support/Downloads</td></tr><tr><td>Laptop</td><td></td><td></td><td></td></tr><tr><td colspan="4">The Optogait system contains the following equipment:</td></tr><tr><td>10 Light-transmitting (T) bars (1 as a first meter)</td><td></td><td></td><td></td></tr><tr><td>10 Light-receiving (R) bars (1 as a first meter)</td><td></td><td></td><td></td></tr><tr><td>18 Caps to connect the bars within a set (9 for T and 9 for R bars) and 2 special caps for the last T and R bar</td><td></td><td></td><td></td></tr><tr><td>1 Camera with its tripod</td><td></td><td></td><td></td></tr><tr><td>1 Cable for connecting the Optogait to the laptop</td><td></td><td></td><td></td></tr><tr><td>1 Cable for connecting the camera to the laptop</td><td></td><td></td><td></td></tr><tr><td>2 Power supplies (one for each set of bars)</td><td></td><td></td><td></td></tr></tbody></table>

clinical assessment of spatiotemporal gait parameters in patients and older adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

A recent study demonstrated the validity of the photoelectric system against a criterion instrument (a validated electronic walkway) for the assessment of spatiotemporal gait parameters in orthopedic patients and healthy elderly controls7. The same between-group differences in gait variables were detected by the two systems. Although concurrent validity was excellent, with intraclass correlation coefficients ranging between 0.933 and 0.999 (p &#60; 0.001), a systematic bias (p &#60; 0.001) was observed between...

Watch this Scientific Journal Video about Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults at JoVE.com

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

clinical-assessment-spatiotemporal-gait-parameters-patients-older

Research

JoVE Journal

Medicine

13.8K Views.  Schulthess Clinic. This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

Video: Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

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.

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 ...

Behavior

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, ...

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 ...

Gait Analysis of Age-dependent Motor Impairments in Mice with Neurodegeneration

Motor behavior tests are commonly used to determine the functional relevance of a rodent model and to test newly developed treatments in these animals. Specifically, gait analysis allows recapturing disease relevant phenotypes that are observed in human patients, especially in neurodegenerative diseases that affect motor abilities such as Parkinson&#39;s disease (PD), Alzheimer&#39;s disease (AD), amyotrophic lateral sclerosis (ALS), and others. In early studies along this line, the measurement of gait parameters was laborious and depended on factors that were hard to control (e.g., running speed, continuous running). The development of ventral plane imaging (VPI) systems made it feasible to perform gait analysis at a large scale, making this method a useful tool for the assessment of motor behavior in rodents. Here, we present an in-depth protocol of how to use kinematic gait analysis to examine the age-dependent progression of motor deficits in mouse models of neurodegeneration; mouse lines with decreased levels of endophilin, in which neurodegenerative damage progressively increases with age, are used as an example.

In this study, we demonstrate the use of kinematic gait analysis based on ventral plane imaging to monitor the subtle changes in motor coordination as well as the progression of neurodegeneration with advancing age in mouse models (e.g., endophilin mutant mouse lines).

Motor behavior tests are commonly used to determine the functional relevance of a rodent model and to test newly developed treatments in these animals. ...

Developmental Biology

Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease

This study presents a protocol for virtual and in-person walking groups for older adults with neurodegenerative diseases and addresses the decline in physical activity and social connectivity during the pandemic. Physical activity, specifically moderate-intensity walking, has been shown to have multiple health benefits for older adults. This methodology was created during the COVID-19 pandemic, contributing to lower physical activity levels and social isolation in older adults. Both the in-person and virtual classes utilize technology such as fitness tracking apps and video platforms. Data are presented from two groups of older adults with neurodegenerative disease: people with prodromal Alzheimer's disease and people with Parkinson's disease. Participants in the virtual classes were screened for balance impairments before the walk, and any person deemed at risk for falls was not eligible to participate virtually. As COVID vaccines became available and restrictions were lifted, in-person walking groups became feasible. Staff and caregivers were trained in balance management, roles/responsibilities, and delivering walking cues. Both walks, virtual and in-person, consisted of a warm up, a walk, and a cool down, and posture, gait, and safety cues were given throughout. Measures of the rate of perceived exertion (RPE) and heart rate (HR) were taken pre-warm up, post-warm up, and at 15 min, 30 min, and 45 min time points. Participants also used a walking application (app) on their phones to record the distance walked and the number of steps taken. The study showed a positive correlation between HR and RPE in both groups. The participants in the virtual group rated the walking group favorably in terms of improving their quality of life during a period of social isolation and contributing to physical, mental, and emotional well-being. The methodology shows a safe and feasible way to implement virtual and in-person walking groups for older adults with neurological diseases.

The present protocol aims to inform rehabilitation specialists and fitness instructors in safe, feasible, and evidence-based methods of delivering virtual and in-person walking classes to older adults with neurodegenerative diseases.

This study presents a protocol for virtual and in-person walking groups for older adults with neurodegenerative diseases and addresses the decline in ...

Video Movement Analysis Using Smartphones (ViMAS): A Pilot Study

The use of smartphones in clinical practice is steadily increasing with the availability of low cost/freely available &#34;apps&#34; that could be used to assess human gait. The primary aim of this manuscript is to test the concurrent validity of kinematic measures recorded by a smartphone application in comparison to a 3D motion capture system in the sagittal plane. The secondary aim was to develop a protocol for clinicians on the set up of the smartphone camera for video movement analysis.
The sagittal plane knee angle was measured during heel strike and toe off events using the smart phone app and a 3D motion-capture system in 32 healthy subjects. Three trials were performed at near (2-m) and far (4-m) smartphone camera distances. The order of the distances was randomized. Regression analysis was performed to estimate the height of the camera based on either the subject&#39;s height or leg length.
Absolute measurement errors were least during toe off (3.12 &#177; 5.44 degrees) compared to heel strike (5.81 &#177; 5.26 degrees). There were significant (p &#60; 0.05) but moderate agreements between the application and 3D motion capture measures of knee angles. There were also no significant (p &#62; 0.05) differences between the absolute measurement errors between the two camera positions. The measurement errors averaged between 3 - 5 degrees during toe off and heel strike events of the gait cycle.
The use of smartphone apps can be a useful tool in the clinic for performing gait or human movement analysis. Further studies are needed to establish the accuracy in measuring movements of the upper extremity and trunk.

Video Movement Analysis Using Smartphones ViMAS: A Pilot Study

This manuscript describes the method to test the concurrent validity of kinematic measures recorded by the smartphone application in comparison to a 3D motion capture system in the sagittal plane. This protocol will enable clinicians to set up smartphones for video capture of human movement.

The use of smartphones in clinical practice is steadily increasing with the availability of low cost/freely available &#34;apps&#34; that could be used to ...

Traditional Trail Making Test Modified into Brand-new Assessment Tools: Digital and Walking Trail Making Test

The Trail Making Test (TMT) is a well-accepted tool for evaluating executive function. The standard TMT was invented more than 60 years ago and has been modified into many versions. With the development of digital technologies, TMT is now modified to a digitized version. The present study demonstrated digital TMT (dTMT) performed on a computer, and Walking TMT (WTMT) on the floor. Both revealed more information compared with the traditional version of TMT.

Here, we present a protocol to show how to perform two types of cognitive assessment tools derived from the paper-pencil version of the Trail Making Test.

The Trail Making Test (TMT) is a well-accepted tool for evaluating executive function. The standard TMT was invented more than 60 years ago and has been ...

Motor Dual-Tasks for Gait Analysis and Evaluation in Post-Stroke Patients

Eighteen stroke patients were recruited for this study involving the evaluation of cognition and walking ability and multitask gait analysis. Multitask gait analysis consisted of a single walking task (Task 0), a simple motor dual-task (water-holding, Task 1), and a complex motor dual-task (crossing obstacles, Task 2). The task of crossing obstacles was considered to be equivalent to the combination of a simple walking task and a complex motor task as it involved more nervous system, skeletal movement, and cognitive resources. To eliminate heterogeneity in the results of the gait analysis of the stroke patients, the dual-task gait cost values were calculated for various kinematic parameters. The major differences were observed in the proximal joint angles, especially in the angles of the trunk, pelvis, and hip joints, which were significantly larger in the dual motor tasks than in the single walking task. This research protocol aims to provide a basis for the clinical diagnosis of gait function and an in-depth study of motor control in stroke patients with motor control deficits through the analyses of dual-motor walking tasks.

This paper presents a protocol specifically for dual motor task gait analysis in stroke patients with motor control deficits.

Eighteen stroke patients were recruited for this study involving the evaluation of cognition and walking ability and multitask gait analysis. Multitask ...

Neuroscience

Evaluating the Risk of Falling in Elderly Using iTUG Motion Capture Technology

Using Motion Capture Technology in the Instrumented Timed Up and Go Test to Detect the Risk of Falling in Aged Adults

Despite efforts made by medicine and technology, the incidence of falls in older adults is still increasing. Therefore, early detection of the falling risk is becoming increasingly important for falling prevention. The Timed Up and Go (TUG) test is a well-accepted tool to assess mobility and can be used in predicting future fall risk in aged adults. In clinical practice, the total time to complete the test is the main outcome measure of the TUG test. Owing to its simplicity and generality, the traditional TUG test has been considered a global test for movement analysis. However, recently, researchers have attempted to split the TUG test into subcomponents and have updated its score system for further investigations. The instrumented Time Up and Go (iTUG) test, which is a new modification of the traditional TUG test, has been reported to be a sensitive tool for predicting movement disorders and the risk of falls in older adults. The goal of the present study was to analyze the iTUG test subcomponents using motion capture technology, and to determine which iTUG test subtasks are related to the potential risk of future falls.

Author Spotlight: Innovations in iTUG Test for Enhanced Risk Assessment and Cognitive Insights

The instrumented Timed Up and Go (iTUG) test is gaining increasing attention in body sway and gait analysis with the development of new technologies. We present a protocol to analyze the subcomponents of the iTUG with motion capture.

Despite efforts made by medicine and technology, the incidence of falls in older adults is still increasing. Therefore, early detection of the falling ...

Motor Exam II

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women&#39;s/Massachusetts General Hospital, Boston, Massachusetts, USA
There are two main types of reflexes that are tested on a neurological examination: stretch (or deep tendon reflexes) and superficial reflexes. A deep tendon reflex (DTR) results from the stimulation of a stretch-sensitive afferent from a neuromuscular spindle, which, via a single synapse, stimulates a motor nerve leading to a muscle contraction. DTRs are increased in chronic upper motor neuron lesions (lesions of the pyramidal tract) and decreased in lower motor neuron lesions and nerve and muscle disorders. There is a wide variation of responses and reflexes graded from 0 to 4+ (Table 1).
DTRs are commonly tested to help localize neurologic disorders. A common method of recording findings during the DTR examination is using a stick figure diagram. The DTR test can help distinguish upper and lower motor neuron problems, and can assist in localizing nerve root compression as well. Although the DTR of nearly any skeletal muscle could be tested, the reflexes that are routinely tested are: brachioradialis, biceps, triceps, patellar, and Achilles (Table 2).
Superficial reflexes are segmental reflex responses that result from stimulation of a specific sensory input (cutaneous or conjunctival) and the corresponding motor response. These reflexes include the corneal, conjunctival, abdominal, cremasteric, anal wink and plantar (Babinski) reflexes. The plantar reflex is a polysynaptic reflex elicited by stroking the lateral aspect of the sole with the normal response being plantar flexion of the great toe. This reflex changes with the normal development of the nervous system. In infants the toe will dorsiflex, but by 2 years of age the toe responds by plantar flexing. With damage to the pyramidal system, there is an unmasking of the more primitive reflex and the toe becomes &#34;upgoing&#34; or a positive Babinski sign.
The evaluations of coordination and gait are performed as a part of the neurological motor examination and can help a clinician localize lesions or recognize movement disorders. The coordination of movements and gait has complex multi-level regulation and requires an integrated function of different components of the nervous system. This part of the neurological examination allows the examiner to assess the function of the cerebellum, the cerebellar connections, and other tracts including brainstem structures. Coordination is assessed by looking for smooth and accurate movement, and requires the integration of sensory feedback with motor output, most of which occurs in the cerebellum. An impaired ability to coordinate the rate, range, timing, direction, or force of voluntary movement is called ataxia. Testing coordination includes evaluation of rapid alternating movements and point-to-point coordination, both of which can be altered as a result of cerebellar dysfunction. As in other parts of the examination, observation is the first step in the evaluation of the patient. A careful observation of a patient&#39;s gait can help the clinician screen for problems including weakness, movement disorders, spasticity, and cerebellar disease. No neurologic examination is complete without the assessment of gait. Occasionally, the only sign of a serious neurologic disorder is an impaired gait.

Motor Exam II: Reflex, Coordination, Gait and Station Testing

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women&#39;s/Massachusetts General Hospital, Boston, Massachusetts, USA
There ...