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Background  Rapid compensatory stepping plays an important role in preventing falls when balance is lost; however, these responses cannot be accurately quantified in the clinic. The Microsoft Kinect™ system provides real-time anatomical landmark position data in three dimensions (3D), which may bridge this gap.    Methods  Compensatory stepping reactions were evoked in 8 young adults by a sudden platform horizontal motion on which the subject stood or walked on a treadmill. The movements were recorded with both a 3D-APAS motion capture and Microsoft Kinect™ systems. The outcome measures consisted of compensatory step times (milliseconds) and length (centimeters). The average values of two standing and walking trials for Microsoft Kinect™ and the 3D-APAS systems were compared using  t -test, Pearson’s correlation, Altman-bland plots, and the average difference of root mean square error (RMSE) of joint position.    Results  The Microsoft Kinect™ had high correlations for the compensatory step times ( r  = 0.75–0.78,  p  = 0.04) during standing and moderate correlations for walking ( r  = 0.53–0.63,  p  = 0.05). The step length, however had a very high correlations for both standing and walking ( r  > 0.97,  p  = 0.01). The RMSE showed acceptable differences during the perturbation trials with smallest relative error in anterior-posterior direction (2-3%) and the highest in the vertical direction (11–13%). No systematic bias were evident in the Bland and Altman graphs.    Conclusions  The Microsoft Kinect™ system provides comparable data to a video-based 3D motion analysis system when assessing step length and less accurate but still clinically acceptable for step times during balance recovery when balance is lost and fall is initiated.

Validity of the microsoft kinect system in assessment of compensatory stepping behavior during standing and treadmill walking