Classification of higher- and lower-mileage runners based on running kinematics.

BACKGROUND: Running-related overuse injuries can result from the combination of extrinsic (e.g., running mileage) and intrinsic risk factors (e.g., biomechanics and gender), but the relationship between these factors is not fully understood. Therefore, the first purpose of this study was to determine whether we could classify higher- and lower-mileage runners according to differences in lower extremity kinematics during the stance and swing phases of running gait. The second purpose was to subgroup the runners by gender and determine whether we could classify higher- and lower-mileage runners in male and female subgroups. METHODS: Participants were allocated to the "higher-mileage" group (≥32 km/week; n = 41 (30 females)) or to the "lower-mileage" group (≤25 km; n = 40 (29 females)). Three-dimensional kinematic data were collected during 60 s of treadmill running at a self-selected speed (2.61 ± 0.23 m/s). A support vector machine classifier identified kinematic differences between higher- and lower-mileage groups based on principal component scores. RESULTS: Higher- and lower-mileage runners (both genders) could be separated with 92.59% classification accuracy. When subgrouping by gender, higher- and lower-mileage female runners could be separated with 89.83% classification accuracy, and higher- and lower-mileage male runners could be separated with 100% classification accuracy. CONCLUSION: These results demonstrate there are distinct kinematic differences between subgroups related to both mileage and gender, and that these factors need to be considered in future research.

Subject-specific and group-based running pattern classification using a single wearable sensor.

The objective of this study was to determine whether subject-specific or group-based models provided better classification accuracy to identify changes in biomechanical running gait patterns across different inclination conditions. The classification process was based on measurements from a single wearable sensor using a total of 41,780 strides from eleven recreational runners while running in real-world and uncontrolled environment. Biomechanical variables included pelvic drop, ground contact time, braking, vertical oscillation of pelvis, pelvic rotation, and cadence were recorded during running on three inclination grades: downhill, -2° to -7°; level, -0.2° to +0.2°; and uphill, +2° to +7°. An ensemble and non-linear machine learning algorithm, random forest (RF), was used to classify inclination condition and determine the importance of each of the biomechanical variables. Classification accuracy was determined for subject-specific and group-based RF models. The mean classification accuracy of all subject-specific RF models was 86.29%, while group-based classification accuracy was 76.17%. Braking was identified as the most important variable for all the runners using the group-based model and for most of the runners based on a subject-specific models. In addition, individual runners used different strategies across different inclination conditions and the ranked order of variable importance was unique for each runner. These results demonstrate that subject-specific models can better characterize changes in gait biomechanical patterns compared to a more traditional group-based approach.

Running patterns for male and female competitive and recreational runners based on accelerometer data.

The purpose of this study was to classify runners in sex-specific groups as either competitive or recreational based on center of mass (CoM) accelerations. Forty-one runners participated in the study (25 male and 16 female), and were labeled as competitive or recreational based on age, sex, and race performance. Three-dimensional acceleration data were collected during a 5-minute treadmill run, and 24 features were extracted. Support vector machine classification models were used to examine the utility of the features in discriminating between competitive and recreational runners within each sex-specific subgroup. Competitive and recreational runners could be classified with 82.63 % and 80.4 % in the male and female models, respectively. Dominant features in both models were related to regularity and variability, with competitive runners exhibiting more consistent running gait patterns, but the specific features were slightly different in each sex-specific model. Therefore, it is important to separate runners into sex-specific competitive and recreational subgroups for future running biomechanical studies. In conclusion, we have demonstrated the ability to analyze running biomechanics in competitive and recreational runners using only CoM acceleration patterns. A runner, clinician, or coach may use this information to monitor how running patterns change as a result of training.

Using wearable sensors to classify subject-specific running biomechanical gait patterns based on changes in environmental weather conditions.

Running-related overuse injuries can result from a combination of various intrinsic (e.g., gait biomechanics) and extrinsic (e.g., running surface) risk factors. However, it is unknown how changes in environmental weather conditions affect running gait biomechanical patterns since these data cannot be collected in a laboratory setting. Therefore, the purpose of this study was to develop a classification model based on subject-specific changes in biomechanical running patterns across two different environmental weather conditions using data obtained from wearable sensors in real-world environments. Running gait data were recorded during winter and spring sessions, with recorded average air temperatures of -10° C and +6° C, respectively. Classification was performed based on measurements of pelvic drop, ground contact time, braking, vertical oscillation of pelvis, pelvic rotation, and cadence obtained from 66,370 strides (~11,000/runner) from a group of recreational runners. A non-linear and ensemble machine learning algorithm, random forest (RF), was used to classify and compute a heuristic for determining the importance of each variable in the prediction model. To validate the developed subject-specific model, two cross-validation methods (one-against-another and partitioning datasets) were used to obtain experimental mean classification accuracies of 87.18% and 95.42%, respectively, indicating an excellent discriminatory ability of the RF-based model. Additionally, the ranked order of variable importance differed across the individual runners. The results from the RF-based machine-learning algorithm demonstrates that processing gait biomechanical signals from a single wearable sensor can successfully detect changes to an individual's running patterns based on data obtained in real-world environments.

Use of baseline pelvic acceleration during running for classifying response to muscle strengthening treatment in patellofemoral pain: A preliminary study.

BACKGROUND: Objectively identifying patients at baseline who may not respond well to a generic muscle strengthening intervention could improve clinical practice by optimizing treatment strategies. The purpose of this study was to determine whether pelvic acceleration measures during running, and clinical and demographic variables could classify patellofemoral pain patients according to their response to a 6-week hip/core and knee exercise-based rehabilitation protocol. METHODS: Forty-one individuals with patellofemoral pain participated in a 6-week exercise intervention program and were sub-grouped into treatment Responders (n = 28) and Non-responders (n = 13) based on self-reported pain and function measures. Baseline pelvic acceleration measures were reduced using a principal component analysis and combined with patient reported outcome measures and demographic variables in a support vector machine to retrospectively classify patient treatment response. FINDINGS: The final classification model had 85.4% classification accuracy, which was significantly better than treatment success rate, with excellent detection rates for Responders (recall: 96.4%), but 23.1% of misclassifications among Non-responders (precision: 90.0%). Thus, it resulted in an F1-score of 0.93 and a Matthews correlation coefficient of 0.69. INTERPRETATION: Overall, the classifier successfully separated patellofemoral pain patients into exercise-based treatment Responders and Non-responders based on a combination of three components of the pelvic accelerations. While this model requires independent validation, it has the potential for further development and to be applied in clinical practice and improve treatment strategies for patellofemoral pain.

Analysis of Big Data in Gait Biomechanics: Current Trends and Future Directions.

The increasing amount of data in biomechanics research has greatly increased the importance of developing advanced multivariate analysis and machine learning techniques, which are better able to handle "big data". Consequently, advances in data science methods will expand the knowledge for testing new hypotheses about biomechanical risk factors associated with walking and running gait-related musculoskeletal injury. This paper begins with a brief introduction to an automated three-dimensional (3D) biomechanical gait data collection system: 3D GAIT, followed by how the studies in the field of gait biomechanics fit the quantities in the 5 V's definition of big data: volume, velocity, variety, veracity, and value. Next, we provide a review of recent research and development in multivariate and machine learning methods-based gait analysis that can be applied to big data analytics. These modern biomechanical gait analysis methods include several main modules such as initial input features, dimensionality reduction (feature selection and extraction), and learning algorithms (classification and clustering). Finally, a promising big data exploration tool called "topological data analysis" and directions for future research are outlined and discussed.

Runners with patellofemoral pain demonstrate sub-groups of pelvic acceleration profiles using hierarchical cluster analysis: an exploratory cross-sectional study.

BACKGROUND: Previous studies have suggested that distinct and homogenous sub-groups of gait patterns exist among runners with patellofemoral pain (PFP), based on gait analysis. However, acquisition of 3D kinematic data using optical systems is time consuming and prone to marker placement errors. In contrast, axial segment acceleration data can represent an overall running pattern, being easy to acquire and not influenced by marker placement error. Therefore, the purpose of this study was to determine if pelvic acceleration patterns during running could be used to classify PFP patients into homogeneous sub-groups. A secondary purpose was to analyze lower limb kinematic data to investigate the practical implications of clustering these subjects based on 3D pelvic acceleration data. METHODS: A hierarchical cluster analysis was used to determine sub-groups of similar running profiles among 110 PFP subjects, separately for males (n = 44) and females (n = 66), using pelvic acceleration data (reduced with principal component analysis) during treadmill running acquired with optical motion capture system. In a secondary analysis, peak joint angles were compared between clusters (α = 0.05) to provide clinical context and deeper understanding of variables that separated clusters. RESULTS: The results reveal two distinct running gait sub-groups (C1 and C2) for female subjects and no sub-groups were identified for males. Two pelvic acceleration components were different between clusters (PC1 and PC5; p < 0.001). While females in C1 presented similar acceleration patterns to males, C2 presented greater vertical and anterior peak accelerations. All females presented higher and delayed mediolateral acceleration peaks than males. Males presented greater ankle eversion (p < 0.001), lower knee abduction (p = 0.007) and hip adduction (p = 0.002) than all females, and lower hip internal rotation than C1 (p = 0.007). CONCLUSIONS: Two distinct and homogeneous kinematic PFP sub-groups were identified for female subjects, but not for males. The results suggest that differences in running gait patterns between clusters occur mainly due to sex-related factors, but there are subtle differences among female subjects. This study shows the potential use of pelvic acceleration patterns, which can be acquired with accessible wearable technology (i.e. accelerometers).

Classifying running speed conditions using a single wearable sensor: Optimal segmentation and feature extraction methods.

Accelerometers have been used to classify running patterns, but classification accuracy and computational load depends on signal segmentation and feature extraction. Stride-based segmentation relies on identifying gait events, a step avoided by using window-based segmentation. For each segment, discrete points can be extracted from the accelerometer signal, or advanced features can be computed. Therefore, the purpose of this study was to examine how different segmentation and feature extraction methods influence the accuracy and computational load of classifying running conditions. Forty-four runners ran at their preferred speed and 25% faster than preferred while an accelerometer at the lower back recorded 3D accelerations. Computational load was determined as the accelerometer signal was segmented into single and five strides, and corresponding small and large windows, with discrete points extracted from the single stride segments and advanced features computed from all four segment types. Each feature set was used to classify speed conditions and classification accuracy was recorded. Computational load and classification accuracy were compared across all feature sets using a repeated-measures MANOVA, with follow-up t-tests to compare feature type (discrete vs. advanced), segmentation method (stride- vs. window-based), and segment size (small vs. large), using a Bonferroni-adjusted α = 0.003. The five-stride (97.49 (±4.57)%) and large-window advanced (97.23 (±5.51)%) feature sets produced the greatest classification accuracy, but the large-window advanced feature set had a lower computational load (0.0041 (±0.0002)s) than the stride-based feature sets. Therefore, using a few advanced features and large overlapping window sizes yields the best performance of both classification accuracy and computational load.

Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain.

PURPOSE: This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP) and healthy controls. METHODS: Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) subgroups on the basis of whether they had been experiencing pain for less or greater than 3 months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP and chronic PFP and healthy controls. RESULTS: Compared with controls, both the acute and chronic PFP subgroups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP subgroup demonstrated greater transverse plane hip motion across stance compared with healthy controls. In contrast, the chronic PFP subgroup demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared with healthy controls. CONCLUSIONS: This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared with healthy controls. Certain discriminating characteristics were shared between both the acute and chronic subgroups when compared with healthy controls, whereas others were specific to the duration of PFP.

Wearable sensors to predict improvement following an exercise intervention in patients with knee osteoarthritis.

BACKGROUND: Muscle strengthening exercises consistently demonstrate improvements in the pain and function of adults with knee osteoarthritis, but individual response rates can vary greatly. Identifying individuals who are more likely to respond is important in developing more efficient rehabilitation programs for knee osteoarthritis. Therefore, the purpose of this study was to determine if pre-intervention multi-sensor accelerometer data (e.g., back, thigh, shank, foot accelerometers) and patient reported outcome measures (e.g., pain, symptoms, function, quality of life) can retrospectively predict post-intervention response to a 6-week hip strengthening exercise intervention in a knee OA cohort. METHODS: Thirty-nine adults with knee osteoarthritis completed a 6-week hip strengthening exercise intervention and were sub-grouped as Non-Responders, Low-Responders, or High-Responders following the intervention based on their change in patient reported outcome measures. Pre-intervention multi-sensor accelerometer data recorded at the back, thigh, shank, and foot and Knee Injury and Osteoarthritis Outcome Score subscale data were used as potential predictors of response in a discriminant analysis of principal components. RESULTS: The thigh was the single best placement for classifying responder sub-groups (74.4%). Overall, the best combination of sensors was the back, thigh, and shank (81.7%), but a simplified two sensor solution using the back and thigh was not significantly different (80.0%; p = 0.27). CONCLUSIONS: While three sensors were best able to identify responders, a simplified two sensor array at the back and thigh may be the most ideal configuration to provide clinicians with an efficient and relatively unobtrusive way to use to optimize treatment.

The use of real-time feedback to improve kinematic marker placement consistency among novice examiners.

Marker placement deviation has been shown to be the largest source of error in gait kinematic data, limiting the ability of clinicians and researchers to conduct between-day or between-center investigations. Prior marker-placement standardization methods are either impractical for a clinical setting or rely on expert marker placement. However, a recently developed, real-time feedback tool has been developed and shown to improve marker placement and downstream kinematic calculations. The purpose of this study was to determine whether this real-time marker-placement tool could improve the consistency of gait kinematic data collected by a group of novice examiners. Twelve novice examiners identified anatomical landmarks and placed retroreflective markers on a single subject. For each examiner, a running trial was analyzed separately using two static trials: (1) PRE and (2) POST implementation of the feedback tool. The protocol was repeated a second time, one week later. Between-examiner consistency was represented by the 95% confidence interval (CI) of the mean joint angles for the entire stride, and compared between the PRE and POST conditions. The POST feedback trials showed an average 27.45% reduction of the 95%CI range for eight out of nine joint angles on day one, and an average 24.73% for five out of nine joint angles on day two, compared to POST. The results indicate a real-time feedback tool improves the consistency in marker placement for novice users.

An expert system feedback tool improves the reliability of clinical gait kinematics for older adults with lower limb osteoarthritis.

Recently, an expert system was developed to provide feedback to examiners with the aim of improving reliability of marker-based gait analysis. The purpose of the current study was to evaluate the effectiveness of this novel feedback tool in improving the reliability of gait analysis for individuals with lower limb osteoarthritis. Three-dimensional gait analysis was conducted for n=27 individuals, at two different time points, and during each session the feedback tool was used to refine marker placement. Results for both discrete variables and support vector machine classifications demonstrated improved reliability of the data with the feedback tool.

Kinematic Gait Patterns in Competitive and Recreational Runners.

Certain homogeneous running subgroups demonstrate distinct kinematic patterns in running; however, the running mechanics of competitive and recreational runners are not well understood. Therefore, the purpose of this study was to determine whether we could separate and classify competitive and recreational runners according to gait kinematics using multivariate analyses and a machine learning approach. Participants were allocated to the 'competitive' (n = 20) or 'recreational' group (n = 15) based on age, sex, and recent race performance. Three-dimensional (3D) kinematic data were collected during treadmill running at 2.7 m/s. A support vector machine (SVM) was used to determine if the groups were separable and classifiable based on kinematic time point variables as well as principal component (PC) scores. A cross-fold classification accuracy of 80% was found between groups using the top 5 ranked time point variables, and the groups could be separated with 100% cross-fold classification accuracy using the top 14 ranked PCs explaining 60.29% of the variance in the data. The features were primarily related to pelvic tilt, as well as knee flexion and ankle eversion in late stance. These results suggest that competitive and recreational runners have distinct, 'typical' running patterns that may help explain differences in injury mechanisms.

Reliability of gait analysis using wearable sensors in patients with knee osteoarthritis.

The aim of this study was to determine the test-retest reliability of linear acceleration waveforms collected at the low back, thigh, shank, and foot during walking, in a cohort of knee osteoarthritis patients, by applying two separate sensor attitude correction methods (static attitude correction and dynamic attitude correction). Linear acceleration data were collected on the subjects׳ most affected limb during treadmill walking on two separate days. Results reveal all attitude corrected acceleration waveforms displayed high repeatability, with coefficient of multiple determination values ranging from 0.82 to 0.99. Overall, mediolateral accelerations and the thigh sensor demonstrated the lowest reliabilities, but interaction effects revealed only mediolateral accelerations at the thigh and foot sensors were different than other axes and sensor locations. Both attitude correction methods led to improved reliability of linear acceleration waveforms. These findings suggest that while all sensor locations and axes display acceptable reliability in a clinical knee osteoarthritis population, the back and shank locations, and the vertical and anteroposterior acceleration directions, are most reliable.

Gait biomechanics in the era of data science.

Data science has transformed fields such as computer vision and economics. The ability of modern data science methods to extract insights from large, complex, heterogeneous, and noisy datasets is beginning to provide a powerful complement to the traditional approaches of experimental motion capture and biomechanical modeling. The purpose of this article is to provide a perspective on how data science methods can be incorporated into our field to advance our understanding of gait biomechanics and improve treatment planning procedures. We provide examples of how data science approaches have been applied to biomechanical data. We then discuss the challenges that remain for effectively using data science approaches in clinical gait analysis and gait biomechanics research, including the need for new tools, better infrastructure and incentives for sharing data, and education across the disciplines of biomechanics and data science. By addressing these challenges, we can revolutionize treatment planning and biomechanics research by capitalizing on the wealth of knowledge gained by gait researchers over the past decades and the vast, but often siloed, data that are collected in clinical and research laboratories around the world.

Determination of patellofemoral pain sub-groups and development of a method for predicting treatment outcome using running gait kinematics.

BACKGROUND: Not all patients with patellofemoral pain exhibit successful outcomes following exercise therapy. Thus, the ability to identify patellofemoral pain subgroups related to treatment response is important for the development of optimal therapeutic strategies to improve rehabilitation outcomes. The purpose of this study was to use baseline running gait kinematic and clinical outcome variables to classify patellofemoral pain patients on treatment response retrospectively. METHODS: Forty-one individuals with patellofemoral pain that underwent a 6-week exercise intervention program were sub-grouped as treatment Responders (n=28) and Non-responders (n=13) based on self-reported measures of pain and function. Baseline three-dimensional running kinematics, and self-reported measures underwent a linear discriminant analysis of the principal components of the variables to retrospectively classify participants based on treatment response. The significance of the discriminant function was verified with a Wilk's lambda test (α=0.05). FINDINGS: The model selected 2 gait principal components and had a 78.1% classification accuracy. Overall, Non-responders exhibited greater ankle dorsiflexion, knee abduction and hip flexion during the swing phase and greater ankle inversion during the stance phase, compared to Responders. INTERPRETATION: This is the first study to investigate an objective method to use baseline kinematic and self-report outcome variables to classify on patellofemoral pain treatment outcome. This study represents a significant first step towards a method to help clinicians make evidence-informed decisions regarding optimal treatment strategies for patients with patellofemoral pain.

Predicting ground contact events for a continuum of gait types: An application of targeted machine learning using principal component analysis.

An ongoing challenge in the application of gait analysis to clinical settings is the standardized detection of temporal events, with unobtrusive and cost-effective equipment, for a wide range of gait types. The purpose of the current study was to investigate a targeted machine learning approach for the prediction of timing for foot strike (or initial contact) and toe-off, using only kinematics for walking, forefoot running, and heel-toe running. Data were categorized by gait type and split into a training set (∼30%) and a validation set (∼70%). A principal component analysis was performed, and separate linear models were trained and validated for foot strike and toe-off, using ground reaction force data as a gold-standard for event timing. Results indicate the model predicted both foot strike and toe-off timing to within 20ms of the gold-standard for more than 95% of cases in walking and running gaits. The machine learning approach continues to provide robust timing predictions for clinical use, and may offer a flexible methodology to handle new events and gait types.

Kinematic gait patterns and their relationship to pain in mild-to-moderate hip osteoarthritis.

BACKGROUND: Mild-to-moderate hip osteoarthritis is often managed clinically in a non-surgical manner. Effective non-surgical management of this population requires characterizing the specific impairments within this group. To date, a complete description of all lower extremity kinematics in mild-to-moderate hip osteoarthritis patients has not been presented. The aim of the present study is to describe the lower extremity gait kinematics in mild-to-moderate hip osteoarthritis patients and explore the relationship between kinematics and pain. METHODS: 22 subjects with mild-to-moderate radiographic hip osteoarthritis (Kellgren-Lawrence grade 2-3) and 22 healthy age and BMI matched control subjects participated. Kinematic treadmill walking data were collected across all lower extremity joints. A two-way repeated measures analysis of variance estimated mean differences in gait kinematics between groups. Correlations between gait kinematics and pain were assessed using a Spearman correlation coefficient. FINDINGS: Hip osteoarthritis subjects hiked their unsupported hemi-pelvis 1.40° (P<0.001) more than controls and tilted their pelvis 4.65° more anteriorly (P=0.01). Osteoarthritis subjects walked with 4.30° more peak hip abduction (P<0.001), 8.57° less peak hip extension (P<0.001), and 10.54° more peak hip external rotation (P<0.001). Kinematics were related to pain in the ankle frontal plane only (r=-0.43, P<0.05). INTERPRETATION: Individuals with mild-to-moderate hip osteoarthritis demonstrate altered gait biomechanics not related to pain. These altered biomechanics may represent effective therapeutic targets by clinicians working with this population. Understanding the underlying patho-anatomic changes that lead to these biomechanical changes requires further investigation.

Gender differences in gait kinematics for patients with knee osteoarthritis.

BACKGROUND: Females have a two-fold risk of developing knee osteoarthritis (OA) as compared to their male counterparts and atypical walking gait biomechanics are also considered a factor in the aetiology of knee OA. However, few studies have investigated sex-related differences in walking mechanics for patients with knee OA and of those, conflicting results have been reported. Therefore, this study was designed to examine the differences in gait kinematics (1) between male and female subjects with and without knee OA and (2) between healthy gender-matched subjects as compared with their OA counterparts. METHODS: One hundred subjects with knee OA (45 males and 55 females) and 43 healthy subjects (18 males and 25 females) participated in this study. Three-dimensional kinematic data were collected during treadmill-walking and analysed using (1) a traditional approach based on discrete variables and (2) a machine learning approach based on principal component analysis (PCA) and support vector machine (SVM) using waveform data. RESULTS: OA and healthy females exhibited significantly greater knee abduction and hip adduction angles compared to their male counterparts. No significant differences were found in any discrete gait kinematic variable between OA and healthy subjects in either the male or female group. Using PCA and SVM approaches, classification accuracies of 98-100% were found between gender groups as well as between OA groups. CONCLUSIONS: These results suggest that care should be taken to account for gender when investigating the biomechanical aetiology of knee OA and that gender-specific analysis and rehabilitation protocols should be developed.

Effects of Simulated Marker Placement Deviations on Running Kinematics and Evaluation of a Morphometric-Based Placement Feedback Method.

In order to provide effective test-retest and pooling of information from clinical gait analyses, it is critical to ensure that the data produced are as reliable as possible. Furthermore, it has been shown that anatomical marker placement is the largest source of inter-examiner variance in gait analyses. However, the effects of specific, known deviations in marker placement on calculated kinematic variables are unclear, and there is currently no mechanism to provide location-based feedback regarding placement consistency. The current study addresses these disparities by: applying a simulation of marker placement deviations to a large (n = 411) database of runners; evaluating a recently published method of morphometric-based deviation detection; and pilot-testing a system of location-based feedback for marker placements. Anatomical markers from a standing neutral trial were moved virtually by up to 30 mm to simulate deviations. Kinematic variables during running were then calculated using the original, and altered static trials. Results indicate that transverse plane angles at the knee and ankle are most sensitive to deviations in marker placement (7.59 degrees of change for every 10 mm of marker error), followed by frontal plane knee angles (5.17 degrees for every 10 mm). Evaluation of the deviation detection method demonstrated accuracies of up to 82% in classifying placements as deviant. Finally, pilot testing of a new methodology for providing location-based feedback demonstrated reductions of up to 80% in the deviation of outcome kinematics.