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Bonato P, Feipel V, Corniani G, Arin-Bal G, Leardini A. Position paper on how technology for human motion analysis and relevant clinical applications have evolved over the past decades: Striking a balance between accuracy and convenience. Gait Posture 2024; 113:191-203. [PMID: 38917666 DOI: 10.1016/j.gaitpost.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Over the past decades, tremendous technological advances have emerged in human motion analysis (HMA). RESEARCH QUESTION How has technology for analysing human motion evolved over the past decades, and what clinical applications has it enabled? METHODS The literature on HMA has been extensively reviewed, focusing on three main approaches: Fully-Instrumented Gait Analysis (FGA), Wearable Sensor Analysis (WSA), and Deep-Learning Video Analysis (DVA), considering both technical and clinical aspects. RESULTS FGA techniques relying on data collected using stereophotogrammetric systems, force plates, and electromyographic sensors have been dramatically improved providing highly accurate estimates of the biomechanics of motion. WSA techniques have been developed with the advances in data collection at home and in community settings. DVA techniques have emerged through artificial intelligence, which has marked the last decade. Some authors have considered WSA and DVA techniques as alternatives to "traditional" HMA techniques. They have suggested that WSA and DVA techniques are destined to replace FGA. SIGNIFICANCE We argue that FGA, WSA, and DVA complement each other and hence should be accounted as "synergistic" in the context of modern HMA and its clinical applications. We point out that DVA techniques are especially attractive as screening techniques, WSA methods enable data collection in the home and community for extensive periods of time, and FGA does maintain superior accuracy and should be the preferred technique when a complete and highly accurate biomechanical data is required. Accordingly, we envision that future clinical applications of HMA would favour screening patients using DVA in the outpatient setting. If deemed clinically appropriate, then WSA would be used to collect data in the home and community to derive relevant information. If accurate kinetic data is needed, then patients should be referred to specialized centres where an FGA system is available, together with medical imaging and thorough clinical assessments.
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Affiliation(s)
- Paolo Bonato
- Dept of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, USA
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Corniani
- Dept of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, USA
| | - Gamze Arin-Bal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey; Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Palmieri M, Donno L, Cimolin V, Galli M. Cervical Range of Motion Assessment through Inertial Technology: A Validity and Reliability Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6013. [PMID: 37447862 DOI: 10.3390/s23136013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Inertial technology has spread widely for its comfortable use and adaptability to various motor tasks. The main objective of this study was to assess the validity of inertial measurements of the cervical spine range of motion (CROM) when compared to that of the optoelectronic system in a group of healthy individuals. A further aim of this study was to determine the optimal placement of the inertial sensor in terms of reliability of the measure, comparing measurements obtained from the same device placed at the second cervical vertebra (C2), the forehead (F) and the external occipital protuberance (EOP). Twenty healthy subjects were recruited and asked to perform flexion-extension, lateral bending, and axial rotation movements of the head. Outcome measurements of interest were CROM and mean angular velocities for each cervical movement. Results showed that inertial measurements have good reliability (0.75 < ICC < 0.9). Excellent reliability (ICC > 0.9) was found in both flexion and right lateral bending angles. All parameters extracted with EOP placement showed ICC > 0.62, while ICC < 0.5 was found in lateral bending mean angular velocities both for F and C2 placements. Therefore, the optimal sensor's positioning emerged to be EOP. These results suggest that inertial technology could be useful and reliable for the evaluation of the CROM.
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Affiliation(s)
- Martina Palmieri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Lucia Donno
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, 28824 Piancavallo, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
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Functional Range of Motion of the Cervical Spine in Cervical Fusion Patients During Activities of Daily Living. J Biomech 2023; 152:111528. [PMID: 36989970 DOI: 10.1016/j.jbiomech.2023.111528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/19/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
Following cervical spine fusion there is a reduction in maximum range of motion (ROM) but how this impacts activity of daily living (ADLs) and quality of life is unknown. This study's purpose is to quantify maximum and functional cervical spine ROM in patients with multi-level cervical fusion (>3 levels) compared to controls during ADLs and to correlate functional range of motion with scores from patient reported outcomes measures (PROs) including the Comparative Pain Scale (CPS), Fear Avoidance Belief Questionnaire (FABQ), and Neck Disability Index (NDI). An inertial measurement unit (IMU) system quantified ROM during ADLs in the extension/flexion, lateral bending, and axial rotation directions of motion. The reliability of this system was compared to standard optical motion tracking. Fourteen participants (8 females, age = 60.0 years (18.7) (median, (interquartile range)) with a history of multi-level cervical fusion (years post-op 0.9 (0.7)) were compared to 16 controls (13 females, age = 52.1 years (15.8)). PROs were collected for each participant. Fusion participants had significantly decreased maximum ROM in all directions of motion. Fusion participants had decreased ROM for some ADLs (backing up a car, using a phone, donning socks, negotiating stairs). CPS, FABQ, and NDI scores were significantly increased in fusion participants. Reductions in two activities (backing up a car, stair negotiation) correlated with a combination of increased PRO scores. Cervical fusion decreases maximum ROM and is correlated with increased PROs in some ADLs, however there is minimal impact on functional ROM. Investigation into velocity and acceleration may yield categorization of pathologic movement.
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Laminectomy and fusion in multilevel degenerative cervical myelopathy -How severely do patients feel restricted by a postoperatively reduced mobility of the cervical spine? Clin Neurol Neurosurg 2020; 197:106160. [DOI: 10.1016/j.clineuro.2020.106160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 01/14/2023]
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Review of existing measurement tools to assess spinal motion during prehospital immobilization. Eur J Emerg Med 2018; 25:161-168. [DOI: 10.1097/mej.0000000000000467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Pancani S, Rowson J, Tindale W, Heron N, Langley J, McCarthy AD, Quinn A, Reed H, Stanton A, Shaw PJ, McDermott CJ, Mazzà C. Assessment of the Sheffield Support Snood, an innovative cervical orthosis designed for people affected by neck muscle weakness. Clin Biomech (Bristol, Avon) 2016; 32:201-6. [PMID: 26673978 DOI: 10.1016/j.clinbiomech.2015.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed at quantifying the biomechanical features of the Sheffield Support Snood, a cervical orthosis specifically designed for patients with neck muscle weakness. The orthosis is designed to be adaptable to a patient's level of functional limitation using adjustable removable supports, which contribute support and restrict movement only in desired anatomical planes. METHODS The snood was evaluated along with two commercially available orthoses, the Vista and Headmaster, in a series of flexion, extension, axial-rotation and lateral flexion movements. Characterization was performed with twelve healthy participants with and without the orthoses. Two inertial-magneto sensors, placed on the forehead and sternum, were used to quantify the neck's range of motion. FINDINGS In its less supportive configuration, the snood was effective in limiting movements to the desired planes, preserving free movement in other planes. The Headmaster was only effective in limiting flexion. The range of motion achieved with the snood in its rigid configuration was equivalent (P>0.05, effect size<0.4) to that achieved with the Vista, both in trials performed reaching the maximum amplitude (range of motion reduction: 25%-34% vs 24%-47%) and at maximum speed (range of motion reduction: 24%-29% vs 25%-43%). INTERPRETATION The Sheffield Support Snood is effectively adaptable to different tasks and, in its most supportive configuration, offers a support comparable to the Vista, but providing a less bulky structure. The chosen method is suitable for the assessment of range of motions while wearing neck orthoses and is easily translatable in a clinical context.
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Affiliation(s)
- Silvia Pancani
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK; Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK.
| | - Jennifer Rowson
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK; Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK
| | - Wendy Tindale
- Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK; National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Nicola Heron
- National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Joe Langley
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Avril D McCarthy
- Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK; National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK; School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ann Quinn
- South Yorkshire Motor Neurone Disease Association, Sheffield, UK
| | - Heath Reed
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Andrew Stanton
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Christopher J McDermott
- National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK; Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK; Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK
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Hobert MA, Maetzler W, Aminian K, Chiari L. Technical and clinical view on ambulatory assessment in Parkinson's disease. Acta Neurol Scand 2014; 130:139-47. [PMID: 24689772 DOI: 10.1111/ane.12248] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Abstract
With the progress of technologies of recent years, methods have become available that use wearable sensors and ambulatory systems to measure aspects of--particular axial--motor function. As Parkinson's disease (PD) can be considered a model disorder for motor impairment, a significant number of studies have already been performed with these patients using such techniques. In general, motion sensors such as accelerometers and gyroscopes are used, in combination with lightweight electronics that do not interfere with normal human motion. A fundamental advantage in comparison with usual clinical assessment is that these sensors allow a more quantitative, objective, and reliable evaluation of symptoms; they have also significant advantages compared to in-lab technologies (e.g., optoelectronic motion capture) as they allow long-term monitoring under real-life conditions. In addition, based on recent findings particularly from studies using functional imaging, we learned that non-motor symptoms, specifically cognitive aspects, may be at least indirectly assessable. It is hypothesized that ambulatory quantitative assessment strategies will allow users, clinicians, and scientists in the future to gain more quantitative, unobtrusive, and everyday relevant data out of their clinical evaluation and can also be designed as pervasive (everywhere) and intensive (anytime) tools for ambulatory assessment and even rehabilitation of motor and (partly) non-motor symptoms in PD.
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Affiliation(s)
- M. A. Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research; Department of Neurodegenerative Diseases; University of Tübingen; Tübingen Germany
- DZNE; German Center for Neurodegenerative Diseases; Tübingen Germany
| | - W. Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research; Department of Neurodegenerative Diseases; University of Tübingen; Tübingen Germany
- DZNE; German Center for Neurodegenerative Diseases; Tübingen Germany
| | - K. Aminian
- Ecole Polytechnique Fédérale de Lausanne; Laboratory of Movement Analysis and Measurement; Lausanne Switzerland
| | - L. Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”; University of Bologna; Bologna Italy
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Park MS, Mesfin A, Stoker GE, Song KS, Kennedy C, Riew KD. Sagittal range of motion after extensive cervical fusion. Spine J 2014; 14:338-43. [PMID: 24021620 DOI: 10.1016/j.spinee.2013.06.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 05/31/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Complicated cervical spine revision and deformity correction surgeries are becoming increasingly common. These challenging operations often necessitate fusion of the entire cervical spine. Patients frequently express concern over the likely loss of range of motion (ROM) of the neck postoperatively. However, we are aware of no study that specifically examines the sagittal cervical ROM after extensive cervical fusion. PURPOSE To characterize sagittal ROM after extensive cervical fusion. STUDY DESIGN Retrospective case series. PATIENT SAMPLE Thirty patients were included. OUTCOME MEASURES Radiographs at final follow-up were measured for cervical ROM by the occipitocervical and cervicosternal angles with the neck in full flexion and extension. METHODS The surgical and medical records at one tertiary referral academic institution were used to identify adults who had undergone extensive cervical fusion between 1996 and 2008. An "extensive cervical fusion" entailed an upper instrumented vertebra proximal to C3 and lower instrumented vertebra distal to C7. Radiographs at final follow-up were measured for cervical ROM by the occipitocervical and cervicosternal angles with the neck in full flexion and extension. RESULTS The average age at surgery was 58.3±10.0 years. The surgical levels were occiput-T1 (one patient), occiput-T4 (one patient), occiput-T6 (one patient), C1-T1 (one patient), C1-T2 (one patient), C2-T1 (nine patients), C2-T2 (eight patients), C2-T3 (six patients), and C2-T4 (two patients). Twenty-seven of the procedures were revisions. The other surgical indications were chin-on-chest deformity (one patient), cervical scoliosis (one patient), and multilevel cervical myelopathy (one patient). The mean follow-up period was 34.5±30.9 months (range, 6-154 months). The mean cervical ROM values by the occipitocervical and cervicosternal angles were 29.5±11.0° and 7.5±5.0°, respectively. The mean total cervical ROM value was 34.1±14.7°. CONCLUSIONS A substantial degree of sagittal ROM can be maintained after extensive surgical fusion of the cervical spine.
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Affiliation(s)
- Moon Soo Park
- Department of Orthopaedic Surgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Geoffrey E Stoker
- Department of Orthopedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110, USA
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Heukseok-dong, Dongjak-gu, 224-1, Seoul 156-861, Republic of Korea
| | - Carie Kennedy
- Department of Orthopedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110, USA.
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Gait and foot clearance parameters obtained using shoe-worn inertial sensors in a large-population sample of older adults. SENSORS 2013; 14:443-57. [PMID: 24379049 PMCID: PMC3926567 DOI: 10.3390/s140100443] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022]
Abstract
In order to distinguish dysfunctional gait, clinicians require a measure of reference gait parameters for each population. This study provided normative values for widely used parameters in more than 1,400 able-bodied adults over the age of 65. We also measured the foot clearance parameters (i.e., height of the foot above ground during swing phase) that are crucial to understand the complex relationship between gait and falls as well as obstacle negotiation strategies. We used a shoe-worn inertial sensor on each foot and previously validated algorithms to extract the gait parameters during 20 m walking trials in a corridor at a self-selected pace. We investigated the difference of the gait parameters between male and female participants by considering the effect of age and height factors. Besides; we examined the inter-relation of the clearance parameters with the gait speed. The sample size and breadth of gait parameters provided in this study offer a unique reference resource for the researchers.
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Duc C, Salvia P, Lubansu A, Feipel V, Aminian K. A wearable inertial system to assess the cervical spine mobility: comparison with an optoelectronic-based motion capture evaluation. Med Eng Phys 2013; 36:49-56. [PMID: 24075589 DOI: 10.1016/j.medengphy.2013.09.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 11/19/2022]
Abstract
In clinical settings, the cervical range of motion (ROM) is commonly used to assess cervical spine function. This study aimed at assessing cervical spine mobility based on head and thorax kinematics measured with a wearable inertial system (WS). Sequences of imposed active head movements (lateral bending, axial rotation and flexion-extension) were recorded in ten controls and 13 patients who had undergone an arthrodesis. Orientation of the head relative to the thorax was computed in terms of 3D helical angles and compared with the values obtained using an optoelectronic reference system (RS). Movement patterns from WS and RS showed excellent concurrent validity (CMC up to 1.00), but presented slight differences of bias (mean bias<2.5°) and dispersion (mean dispersion<4.2°). ROM obtained using WS also showed some differences compared to RS (mean difference<5.7°), within the range of those reported in literature. WS enabled the observation of the same significant differences between controls and patients as RS. Moreover, ROM from WS presented good test-retest repeatability (ICC between 0.63 and 0.99 and SEM<6.2°). In conclusion, WS can provide angles and ROM comparable to those obtained with RS and relevant for the cervical assessment after treatment.
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Affiliation(s)
- C Duc
- Laboratory of Movement Analysis and Measurement (LMAM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.
| | - P Salvia
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles (ULB), Belgium
| | - A Lubansu
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles (ULB), Belgium; Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles (ULB), Belgium
| | - V Feipel
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles (ULB), Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Belgium
| | - K Aminian
- Laboratory of Movement Analysis and Measurement (LMAM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.
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