Learning outside the lab
Photos by Ashley Barnas April 27, 2023
Wearable tech helps 91原创 biomechanics researchers get first glimpse at everyday walking patterns
When you walk in a clinical setting, you鈥檙e often walking in a straight line and faster than you normally would. It鈥檚 because you鈥檙e being watched.
鈥淗istorically, we鈥檝e gleaned a lot of information from bringing people into the lab and conducting precise measurements, but that information isn鈥檛 indicative of their behavior in the real world,鈥 said Jocelyn Hafer.
The assistant professor of kinesiology and applied physiology in the 91原创 College of Health Sciences is one of the few biomechanists looking to get beyond the well-documented 鈥渨hite coat effect鈥 and gauge gait in people鈥檚 everyday lives without a researcher watching over their every move, influencing their behavior.
Using innovative wearable technology and funded through a $434,761 from the National Institutes of Health, Hafer will gain a wealth of data about people鈥檚 walking patterns and joint ranges of motion.
鈥淥ften in the lab, we鈥檒l get 10 strides from a person, and we consider that enough to understand their movements, but they don鈥檛 turn, speed up or slow down,鈥 Hafer said. 鈥淯sing this real-world data, we鈥檒l get thousands of steps for each person, so it鈥檚 a much more powerful data set.鈥
Julien Mihy, doctoral student in biomechanics and movement science (), whose past research has focused on running mechanics and injuries, has been working alongside Hafer in the since the project鈥檚 inception.
鈥淚鈥檓 very interested in looking at what people do 99% of their life as opposed to the 1% in the lab,鈥 Mihy said. 鈥淲hen people are walking, do they have varying speed? Are people doing stairs? How are they getting out of cars, and what does that look like? Those are questions we鈥檙e seeking answers to because we need to have a better understanding of their movements if we want to improve certain tasks.鈥
Study participants will wear sophisticated sensors, the size of an AppleWatch, on their feet, calves, thighs, and waist over the course of three days and just go about their everyday lives. The sensors are equipped with accelerometers, gyroscopes and magnetometers that will calculate segment motions and joint excursions.
鈥淧revious research with sensors on the foot show steps and speed, but measuring movement at the joint level is much more challenging, so we鈥檙e trying to add to that body of knowledge,鈥 Hafer said.
Participants include 30 adults in three categories: the young and healthy aged 21-35; those 55-70 years old with no orthopedic problems, and those 55-70 years old with knee osteoarthritis. She expects certain conditions to be more amplified outside the lab.聽聽
鈥淧eople walk slower, on average, when they鈥檙e not in the lab,鈥 Hafer said. 鈥淲hen we look at step or stride length, oftentimes as people get older or as they have increases in orthopedic conditions, their stride length gets shorter, and they take more steps per minute. Shuffling gait is the extreme of that.鈥
Jennifer Kraut, who鈥檚 physically active, was an early volunteer for the study. She鈥檚 in the healthy control group.聽
鈥淚 enjoy furthering research,鈥 said Kraut, who plays tennis, cycles, and does weightlifting and yoga.
Kraut was a prime example of the 鈥渨hite coat effect鈥 that researchers like Hafer and Mihy are trying to push past.
鈥淲hile I was in the lab, I was hyper aware of how I was walking,鈥 Kraut said. 鈥淭hey had me walk at a 鈥榥ormal鈥 rate, and I think my normal pace is quicker. Then, they had me walk at a quicker rate, and I was very aware that I was taking teeny tiny steps to go faster, and I started to feel tight. It wasn鈥檛 uncomfortable, but I was aware of how I鈥檓 walking, and I usually don鈥檛 think about it.鈥澛
She said the sensors are barely noticeable.聽
鈥淚鈥檓 only aware of the sensors when I鈥檓 changing my shoes,鈥 Kraut said. 鈥淭hey鈥檙e more comfortable than a FitBit, and I don鈥檛 think wearing them will have any impact on my day.鈥澛
Hafer is eager to capture data on participants鈥 joint movements as they climb stairs and learn how their walking patterns change after they鈥檝e been sedentary for a period and then stand up to walk.聽
鈥淚 want to learn how variable people鈥檚 walking patterns are throughout a day and between days,鈥 Hafer said.聽
Study participants will also get text questionnaires throughout the day asking them about their pain and fatigue levels.聽
鈥淲e expect people will do more in the real-world than they do in the lab, so that adds variability,鈥 Hafer said. 鈥淏ut pain is such a factor in those with knee osteoarthritis, so pain and fatigue will add even more variability to how people are moving. I think that will be really interesting and will give us a wealth of data to explore how pain and fatigue impacts joint health.鈥
Mihy is excited to correlate the biomechanics data with people鈥檚 responses to the questionnaires.
鈥淲ith knee osteoarthritis, there鈥檚 fluctuations in pain and fatigue throughout the day,鈥 Mihy said. 鈥淧atients come into a physician鈥檚 office when they鈥檙e at their best or when they鈥檙e in pain, but that doesn鈥檛 reflect the other 23 hours of the day. So, understanding how pain and fatigue fluctuates and how that affects a person鈥檚 mechanics in a day on a larger scale will help inform clinicians.鈥澛
Mihy added being among the first to measure gait outside a lab setting is inspiring.
鈥淚t鈥檚 amazing,鈥 he said. 鈥淏ut when you鈥檙e the first to do it, there鈥檚 no baseline, so that鈥檚 challenging. But it鈥檚 been enjoyable to showcase our research and elaborate on our methods.鈥澛
In the future, Hafer hopes to conduct larger longitudinal studies in people with knee osteoarthritis.聽
鈥淥ne of the real difficulties is identifying individuals with knee osteoarthritis who will see a faster disease progression,鈥 Hafer said. 鈥淩esearch in labs and clinical studies, thus far, has not been able to identify that.鈥
Earlier identification of disease progression could promote earlier rehabilitation and interventions. Hafer hopes to see the research progress to a point where knee degeneration could be slowed to prevent osteoarthritis.
鈥淧eople often don鈥檛 go to the doctor until their knee hurts, and by that time, they may already have knee osteoarthritis,鈥 she said. 鈥淭here could be previously undetectable changes in knee range of motion or changes in the variability of walking patterns day to day that we haven鈥檛 quantified yet.鈥
Hafer said earlier detection of slow declines could help a patient鈥檚 prognosis.聽聽
鈥淚s the way someone walks in the real world a more sensitive marker of early decline than the way that they walk in the lab?鈥 Hafer asked. 鈥淭hat鈥檚 one of many questions we鈥檙e trying to answer with this research.
鈥淚magine if physicians equipped patients with sensors regularly for a few days every year, they could observe data on how people are moving and identify declines before a person鈥檚 knee starts to hurt, so a person鈥檚 everyday gait and movement could be an early red flag.鈥澛
The Gait Biomechanics Research Laboratory is still recruiting participants for this study. Please email gaitbiomechlab@udel.edu for more information.
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