Human movement analysis using stereophotogrammetry. Part 1: theoretical background

Knee braces and foot orthoses multimodal 3-month treatment of medial knee osteoarthritis in a randomised crossover trial

PURPOSE

Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment.

METHODS

Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM.

RESULTS

An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO.

CONCLUSION

The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes.

LEVEL OF EVIDENCE

Therapeutic study level I randomised crossover trial.

Kinetic and kinematic strategies integrating the trunk and lower limbs for a powerful soccer kick in amateur players

This study investigated the kinematic (KmS) and kinetic (KnS) strategies integrating the trunk and lower limbs to achieve maximal kicking performance. Although strategies consisting of individual joint movements or moments are known, strategies combining joint movements or moments of the trunk and lower limbs have been less studied. Fifty adult amateur soccer players were assessed. Peak joint angles and moments of the trunk, the hip of the supporting limb, the hip and knee of the kicking limb, and the velocities of the foot and ball were recorded. Canonical Correlation Analysis evaluated relationships between sets of variables. A combination of greater hip extension and knee flexion of the kicking limb, as a KmS, correlated with better kick performance (Rc = 0.60, p = 0.004). Furthermore, a combination of larger moments of trunk flexion and rotation, internal rotation of the supporting hip, hip flexion, and knee extension of the kicking limb, as a KnS, were associated with better performance (Rc = 0.74, p < 0.001). The explained variance was 43% for the KmS and 59% for the KnS. In amateur players, the KmS for better kick performance involved greater hip and knee movement of the kicking limb, while the KnS involved greater moments at the trunk and both lower limbs.

Validity and Reliability of OpenPose-Based Motion Analysis in Measuring Knee Valgus during Drop Vertical Jump Test

OpenPose-based motion analysis (OpenPose-MA), utilizing deep learning methods, has emerged as a compelling technique for estimating human motion. It addresses the drawbacks associated with conventional three-dimensional motion analysis (3D-MA) and human visual detection-based motion analysis (Human-MA), including costly equipment, time-consuming analysis, and restricted experimental settings. This study aims to assess the precision of OpenPose-MA in comparison to Human-MA, using 3D-MA as the reference standard. The study involved a cohort of 21 young and healthy adults. OpenPose-MA employed the OpenPose algorithm, a deep learning-based open-source two-dimensional (2D) pose estimation method. Human-MA was conducted by a skilled physiotherapist. The knee valgus angle during a drop vertical jump task was computed by OpenPose-MA and Human-MA using the same frontal-plane video image, with 3D-MA serving as the reference standard. Various metrics were utilized to assess the reproducibility, accuracy and similarity of the knee valgus angle between the different methods, including the intraclass correlation coefficient (ICC) (1, 3), mean absolute error (MAE), coefficient of multiple correlation (CMC) for waveform pattern similarity, and Pearson's correlation coefficients (OpenPose-MA vs. 3D-MA, Human-MA vs. 3D-MA). Unpaired t-tests were conducted to compare MAEs and CMCs between OpenPose-MA and Human-MA. The ICCs (1,3) for OpenPose-MA, Human-MA, and 3D-MA demonstrated excellent reproducibility in the DVJ trial. No significant difference between OpenPose-MA and Human-MA was observed in terms of the MAEs (OpenPose: 2.4° [95%CI: 1.9-3.0°], Human: 3.2° [95%CI: 2.1-4.4°]) or CMCs (OpenPose: 0.83 [range: 0.99-0.53], Human: 0.87 [range: 0.24-0.98]) of knee valgus angles. The Pearson's correlation coefficients of OpenPose-MA and Human-MA relative to that of 3D-MA were 0.97 and 0.98, respectively. This study demonstrated that OpenPose-MA achieved satisfactory reproducibility, accuracy and exhibited waveform similarity comparable to 3D-MA, similar to Human-MA. Both OpenPose-MA and Human-MA showed a strong correlation with 3D-MA in terms of knee valgus angle excursion.

Trunk biomechanical changes between the sit-to-stand and stand-to-sit performed at self-selected and fast speeds in stroke survivors

PURPOSE

To compare the trunk biomechanical characteristics between the sit-to-stand and stand-to-sit performed at self-selected and fast speeds in stroke survivors and healthy-matched controls.

METHODS

Thirty individuals (15 stroke survivors and 15 healthy-matched controls) were included. The following biomechanical characteristics were determined: peak of trunk forward flexion and time until the peak of trunk forward flexion, total duration, phase I (sit-to-stand: time spent from the beginning to seat-off; stand-to-sit: time spent from the beginning to seat-on) and II durations (sit-to-stand: time spent from seat-off to the end of the task; stand-to-sit: time spent from the seat-on to the end of the task). Two-way repeated measures ANOVA was used (α = 5%).

RESULTS

The maximum angle of trunk forward flexion and time spent until the maximum angle of trunk forward flexion in both tasks were significantly higher in stroke survivors. For both groups and speeds, phase I duration and peak of trunk forward flexion of the stand-to-sit were significantly higher than that of the sit-to-stand (11.41≤F ≤ 33.60; 0.001 ≤ p ≤ 0.002) and, phase II duration was significantly higher during the sit-to-stand than that of the stand-to-sit (21.27 ≤ F ≤ 65.10; p ≤ 0.001).

CONCLUSIONS

These results confirm specific trunk biomechanical characteristics between sit-to-stand and stand-to-sit in stroke survivors and healthy-matched controls.

Functions and Effectiveness of Unloader, Patellofemoral, and Knee Sleeve Orthoses: A Review

Background

Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis-unloader, patellofemoral, and knee sleeves.

Purpose/Research Question

Considering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use.

Results/Synthesis

The knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint.

Conclusion

Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers.

Layman Summary

Knee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.

Metal-backed or all-poly tibial components: which are better for medial unicompartmental knee arthroplasty? A propensity-score-matching retrospective study at the 5-year follow-up

BACKGROUND

This retrospective medium-term follow-up study compares the outcomes of medial fixed-bearing unicompartmental knee arthroplasty (mUKA) using a cemented metal-backed (MB) or an all-polyethylene (AP) tibial component.

MATERIALS AND METHODS

The database of our institution was mined for primary mUKA patients implanted with an MB or an AP tibial component (the MB-UKA and AP-UKA groups, respectively) from 2015 to 2018. We compared patient demographics, patient-reported outcome measures (PROMs), and motion analysis data obtained with the Riablo™ system (CoRehab, Trento, Italy). We conducted propensity-score-matching (PSM) analysis (1:1) using multiple variables.

RESULTS

PSM analysis yielded 77 pairs of MB-UKA and AP-UKA patients. At 5 years, the physical component summary (PCS) score was 52.4 ± 8.3 in MB-UKA and 48.2 ± 8.3 in AP-UKA patients (p < 0.001). The Forgotten Joint Score (FJS-12) was 82.9 ± 18.8 in MB-UKAs and 73.4 ± 22.5 in AP-UKAs (p = 0.015). Tibial pain was reported by 7.8% of the MB-UKA and 35.1% of the AP-UKA patients (p < 0.001). Static postural sway was, respectively, 3.9 ± 2.1 cm and 5.4 ± 2.3 (p = 0.0002), and gait symmetry was, respectively, 92.7% ± 3.7 cm and 90.4% ± 5.4 cm (p = 0.006). Patient satisfaction was 9.2 ± 0.8 in the MB-UKA and 8.3 ± 2.0 in the AP-UKA group (p < 0.003).

CONCLUSIONS

MB-UKA patients experienced significantly better 5-year static sway and gait symmetry outcomes than AP-UKA patients. Although the PROMs of the two groups overlapped, MB-UKA patients had a lower incidence of tibial pain, better FJS-12 and PCS scores, and were more satisfied.

Breathing, postural stability, and psychological health: a study to explore triangular links

Objective

This study aims to test the hypothesis that breathing can be directly linked to postural stability and psychological health. A protocol enabling the simultaneous analysis of breathing, posture, and emotional levels in university students is presented. This aims to verify the possibility of defining a triangular link and to test the adequacy of various measurement techniques.

Participants and Procedure

Twenty-three subjects (9 females and 14 males), aged between 18 and 23 years, were recruited. The experiment consisted of four conditions, each lasting 3 minutes: Standard quiet standing with open eyes 1), with closed eyes 2), and relaxed quiet standing while attempting deep abdominal breathing with open eyes 3) and with closed eyes 4). These latter two acquisitions were performed after subjects were instructed to maintain a relaxed state.

Main Outcome Measures

All subjects underwent postural and stability analysis in a motion capture laboratory. The presented protocol enabled the extraction of 4 sets of variables: Stabilometric data, based on the displacement of the center of pressure and acceleration, derived respectively from force plate and wearable sensors. Postural variables: angles of each joint of the body were measured using a stereophotogrammetric system, implementing the Helen Hayes protocol. Breathing compartment: optoelectronic plethysmography allowed the measurement of the percentage of use of each chest compartment. Emotional state was evaluated using both psychometric data and physiological signals. A multivariate analysis was proposed.

Results

A holistic protocol was presented and tested. Emotional levels were found to be related to posture and the varied use of breathing compartments. Abdominal breathing proved to be a challenging task for most subjects, especially females, who were unable to control their breathing patterns. In males, the abdominal breathing pattern was associated with increased stability and reduced anxiety.

Conclusion

In conclusion, difficulties in performing deep abdominal breathing were associated with elevated anxiety scores and decreased stability. This depicts a circular self-sustaining relationship that may reduce the quality of life, undermine learning, and contribute to muscular co-contraction and the development of musculoskeletal disorders. The presented protocol can be utilized to quantitatively and holistically assess the healthy and/or pathological condition of subjects.

Knee joint prototype based on cam mechanism - design and video analysis

The paper is focused on a design of mechanism accurately reproducing a complex motion in the sagittal plane of a human knee joint. The desired movement is modelled by applying specially designed shapes of cooperating cam elements based on the fixed and moving centroids of knee joint's instantaneous centre of rotation. The mechanism's CAD model and prototype are built using 3D printed elements, providing the possibility of interchanging the elements with cam profiles and adjusting the mechanism's movement to individual needs. The mechanism movement is measured by analysing a video in Matlab and tracking colour markers on the prototype.

[Motion analysis systems in research and for practicing orthopedists]

BACKGROUND

Complex biomechanical motion analysis can provide relevant information for a variety of orthopedic problems. When purchasing motion analysis systems, in addition to the classical measurement quality criteria (validity, reliability, objectivity), spatial and temporal conditions, as well as the requirements for the qualification of the measuring personnel should be considered.

APPLICATION

In complex movement analysis, systems are used to determine kinematics, kinetics and muscle activity (electromyography). This article gives an overview of methods of complex biomechanical motion analysis for use in orthopaedic research or for individual patient care. In addition to the use for pure movement analysis, the use of movement analysis methods in the field of biofeedback training is discussed.

ACQUISITION

For the specific acquisition of motion analysis systems, it is recommended to contact professional societies (e.g., the German Society for Biomechanics),universities with existing motion analysis facilities or distributors in the field of biomechanics.

Technological Solutions for Human Movement Analysis in Obese Subjects: A Systematic Review

Obesity has a critical impact on musculoskeletal systems, and excessive weight directly affects the ability of subjects to realize movements. It is important to monitor the activities of obese subjects, their functional limitations, and the overall risks related to specific motor tasks. From this perspective, this systematic review identified and summarized the main technologies specifically used to acquire and quantify movements in scientific studies involving obese subjects. The search for articles was carried out on electronic databases, i.e., PubMed, Scopus, and Web of Science. We included observational studies performed on adult obese subjects whenever reporting quantitative information concerning their movement. The articles must have been written in English, published after 2010, and concerned subjects who were primarily diagnosed with obesity, thus excluding confounding diseases. Marker-based optoelectronic stereophotogrammetric systems resulted to be the most adopted solution for movement analysis focused on obesity; indeed, wearable technologies based on magneto-inertial measurement units (MIMUs) were recently adopted for analyzing obese subjects. Further, these systems are usually integrated with force platforms, so as to have information about the ground reaction forces. However, few studies specifically reported the reliability and limitations of these approaches due to soft tissue artifacts and crosstalk, which turned out to be the most relevant problems to deal with in this context. In this perspective, in spite of their inherent limitations, medical imaging techniques-such as Magnetic Resonance Imaging (MRI) and biplane radiography-should be used to improve the accuracy of biomechanical evaluations in obese people, and to systematically validate less-invasive approaches.

Markerless motion capture estimates of lower extremity kinematics and kinetics are comparable to marker-based across 8 movements

Motion analysis is essential for assessing in-vivo human biomechanics. Marker-based motion capture is the standard to analyze human motion, but the inherent inaccuracy and practical challenges limit its utility in large-scale and real-world applications. Markerless motion capture has shown promise to overcome these practical barriers. However, its fidelity in quantifying joint kinematics and kinetics has not been verified across multiple common human movements. In this study, we concurrently captured marker-based and markerless motion data on 10 healthy subjects performing 8 daily living and exercise movements. We calculated the correlation (R xy ) and root-mean-square difference (RMSD) between markerless and marker-based estimates of ankle dorsi-plantarflexion, knee flexion, and three-dimensional hip kinematics (angles) and kinetics (moments) during each movement. Estimates from markerless motion capture matched closely with marker-based in ankle and knee joint angles (R xy ≥ 0.877, RMSD ≤ 5.9°) and moments (R xy ≥ 0.934, RMSD ≤ 2.66 % height × weight). High outcome comparability means the practical benefits of markerless motion capture can simplify experiments and facilitate large-scale analyses. Hip angles and moments demonstrated more differences between the two systems (RMSD: 6.7° - 15.9° and up to 7.15 % height × weight), especially during rapid movements such as running. Markerless motion capture appears to improve the accuracy of hip-related measures, yet more research is needed for validation. We encourage the biomechanics community to continue verifying, validating, and establishing best practices for markerless motion capture, which holds exciting potential to advance collaborative biomechanical research and expand real-world assessments needed for clinical translation.

Characterization of Infants' General Movements Using a Commercial RGB-Depth Sensor and a Deep Neural Network Tracking Processing Tool: An Exploratory Study

Cerebral palsy, the most common childhood neuromotor disorder, is often diagnosed through visual assessment of general movements (GM) in infancy. This skill requires extensive training and is thus difficult to implement on a large scale. Automated analysis of GM performed using low-cost instrumentation in the home may be used to estimate quantitative metrics predictive of movement disorders. This study explored if infants' GM may be successfully evaluated in a familiar environment by processing the 3D trajectories of points of interest (PoI) obtained from recordings of a single commercial RGB-D sensor. The RGB videos were processed using an open-source markerless motion tracking method which allowed the estimation of the 2D trajectories of the selected PoI and a purposely developed method which allowed the reconstruction of their 3D trajectories making use of the data recorded with the depth sensor. Eight infants' GM were recorded in the home at 3, 4, and 5 months of age. Eight GM metrics proposed in the literature in addition to a novel metric were estimated from the PoI trajectories at each timepoint. A pediatric neurologist and physiatrist provided an overall clinical evaluation from infants' video. Subsequently, a comparison between metrics and clinical evaluation was performed. The results demonstrated that GM metrics may be meaningfully estimated and potentially used for early identification of movement disorders.

Biosignal processing methods to explore the effects of side-dominance on patterns of bi- and unilateral standing stability in healthy young adults

We examined the effects of side-dominance on the laterality of standing stability using ground reaction force, motion capture (MoCap), and EMG data in healthy young adults. We recruited participants with strong right (n = 15) and left (n = 9) hand and leg dominance (side-dominance). They stood on one or two legs on a pair of synchronized force platforms for 50 s with 60 s rest between three randomized stance trials. In addition to 23 CoP-related variables, we also computed six MoCap variables representing each lower-limb joint motion time series. Moreover, 39 time- and frequency-domain features of EMG data from five muscles in three muscle groups were analyzed. Data from the multitude of biosignals converged and revealed concordant patterns: no differences occurred between left- and right-side dominant participants in kinetic, kinematic, or EMG outcomes during bipedal stance. Regarding single leg stance, larger knee but lower ankle joint kinematic values appeared in left vs right-sided participants during non-dominant stance. Left-vs right-sided participants also had lower medial gastrocnemius EMG activation during non-dominant stance. While right-side dominant participants always produced larger values for kinematic data of ankle joint and medial gastrocnemius EMG activation during non-dominant vs dominant unilateral stance, this pattern was the opposite for left-sided participants, showing larger values when standing on their dominant vs non-dominant leg, i.e., participants had a more stable balance when standing on their right leg. Our results suggest that side-dominance affects biomechanical and neuromuscular control strategies during unilateral standing.

Can We Quantify Aging-Associated Postural Changes Using Photogrammetry? A Systematic Review

BACKGROUND

Aging is widely known to be associated with changes in standing posture. Recent advancements in the field of computerized image processing have allowed for improved analyses of several health conditions using photographs. However, photogrammetry's potential for assessing aging-associated postural changes is yet unclear. Thus, the aim of this review is to evaluate the potential of photogrammetry in quantifying age-related postural changes.

MATERIALS AND METHODS

We searched the databases PubMed Central, Scopus, Embase, and SciELO from the beginning of records to March 2021. Inclusion criteria were: (a) participants were older adults aged ≥60; (b) standing posture was assessed by photogrammetric means. PRISMA guidelines were followed. We used the Newcastle-Ottawa Scale to assess methodological quality.

RESULTS

Of 946 articles reviewed, after screening and the removal of duplicates, 11 reports were found eligible for full-text assessment, of which 5 full studies met the inclusion criteria. Significant changes occurring with aging included deepening of thoracic kyphosis, flattening of lumbar lordosis, and increased sagittal inclination.

CONCLUSIONS

These changes agree with commonly described aging-related postural changes. However, detailed quantification of these changes was not found; the photogrammetrical methods used were often unvalidated and did not adhere to known protocols. These methodological difficulties call for further studies using validated photogrammetrical methods and improved research methodologies.

Review on Mandibular Muscle Kinematics

The complexity of mandibular dynamics encourages constant research as a vehicle to improve oral health. The gold standard motion capture system might help us to understand its functioning and its relation to body position, aiming to perform an exhaustive bibliographic review in the Dentistry field. Six different electronic databases were used (Dentistry & Oral Sciences Source, Scopus, Web of Science, PubMed, CINAHL and SPORTDiscus) in April 2022. The selection criteria includes a biography, critical analysis, and the full text from 1984 to April 2022, based on the odontological gold standard, whether or not in combination with additional devices. Clinical cases, bibliographic reviews or meta-analysis and grey literature were excluded. The checklist of the critical assessment methodology by Joanna Brigs was used (JBI). After choosing scientific articles published in peer-reviewed journals, 23 out of 186 investigations were classified as eligible with a total of 384 participants. The issue being addressed is related to the speech properties, posture and body movement in relation to dento-oro-facial muscle and facial analysis, mandibular kinematics and mandibular dynamics during the mastication process. The markers arrangement depends on the dynamic to be analysed. From a physiologic and pathologic perspective, the applications of the optic system are relevant in Dentistry. The scarcity of literature obtained implies the need for future research.

Comparison of kinematic parameters of children gait obtained by inverse and direct models

The purpose of this study is to compare differences between kinematic parameters of pediatric gait obtained by direct kinematics (DK) (Plug-in-Gait) and inverse kinematics (IK) (AnyBody) models. Seventeen healthy children participated in this study. Both lower extremities were examined using a Vicon 8-camera motion capture system and a force plate. Angles of the hip, knee, and ankle joints were obtained based on DK and IK models, and ranges of motion (ROMs) were identified from them. The standard error of measurement, root-mean-squared error, correlation r, and magnitude-phase (MP) metrics were calculated to compare differences between the models’ outcomes. The determined standard error of measurement between ROMs from the DK and IK models ranged from 0.34° to 0.58°. A significant difference was found in the ROMs with the exception of the left hip’s internal/external rotation. The mean RMSE of all joints’ amplitudes exceeded the clinical significance limit and was 13.6 ± 4.0°. The best curve angles matching nature were found in the sagittal plane, where r was 0.79 to 0.83 and MP metrics were 0.05 to 0.30. The kinematic parameters of pediatric gait obtained by IK and DK differ significantly. Preferably, all of the results obtained by DK must be validated/verified by IK, in order to achieve a more accurate functional assessment of the individual. Furthermore, the use of IK expands the capabilities of gait analysis and allows for kinetic characterisation.

An Algorithm for Accurate Marker-Based Gait Event Detection in Healthy and Pathological Populations During Complex Motor Tasks

There is growing interest in the quantification of gait as part of complex motor tasks. This requires gait events (GEs) to be detected under conditions different from straight walking. This study aimed to propose and validate a new marker-based GE detection method, which is also suitable for curvilinear walking and step negotiation. The method was first tested against existing algorithms using data from healthy young adults (YA, n = 20) and then assessed in data from 10 individuals from the following five cohorts: older adults, chronic obstructive pulmonary disease, multiple sclerosis, Parkinson’s disease, and proximal femur fracture. The propagation of the errors associated with GE detection on the calculation of stride length, duration, speed, and stance/swing durations was investigated. All participants performed a variety of motor tasks including curvilinear walking and step negotiation, while reference GEs were identified using a validated methodology exploiting pressure insole signals. Sensitivity, positive predictive values (PPV), F1-score, bias, precision, and accuracy were calculated. Absolute agreement [intraclass correlation coefficient (ICC2,1)] between marker-based and pressure insole stride parameters was also tested. In the YA cohort, the proposed method outperformed the existing ones, with sensitivity, PPV, and F1 scores ≥ 99% for both GEs and conditions, with a virtually null bias (&lt;10 ms). Overall, temporal inaccuracies minimally impacted stride duration, length, and speed (median absolute errors ≤1%). Similar algorithm performances were obtained for all the other five cohorts in GE detection and propagation to the stride parameters, where an excellent absolute agreement with the pressure insoles was also found (ICC2,1=0.817− 0.999). In conclusion, the proposed method accurately detects GE from marker data under different walking conditions and for a variety of gait impairments.

Conclusion or Illusion: Quantifying Uncertainty in Inverse Analyses From Marker-Based Motion Capture due to Errors in Marker Registration and Model Scaling

Estimating kinematics from optical motion capture with skin-mounted markers, referred to as an inverse kinematic (IK) calculation, is the most common experimental technique in human motion analysis. Kinematics are often used to diagnose movement disorders and plan treatment strategies. In many such applications, small differences in joint angles can be clinically significant. Kinematics are also used to estimate joint powers, muscle forces, and other quantities of interest that cannot typically be measured directly. Thus, the accuracy and reproducibility of IK calculations are critical. In this work, we isolate and quantify the uncertainty in joint angles, moments, and powers due to two sources of error during IK analyses: errors in the placement of markers on the model (marker registration) and errors in the dimensions of the model’s body segments (model scaling). We demonstrate that IK solutions are best presented as a distribution of equally probable trajectories when these sources of modeling uncertainty are considered. Notably, a substantial amount of uncertainty exists in the computed kinematics and kinetics even if low marker tracking errors are achieved. For example, considering only 2 cm of marker registration uncertainty, peak ankle plantarflexion angle varied by 15.9°, peak ankle plantarflexion moment varied by 26.6 N⋅m, and peak ankle power at push off varied by 75.9 W during healthy gait. This uncertainty can directly impact the classification of patient movements and the evaluation of training or device effectiveness, such as calculations of push-off power. We provide scripts in OpenSim so that others can reproduce our results and quantify the effect of modeling uncertainty in their own studies.

Gait Alterations in Adults after Ankle Fracture: A Systematic Review

(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients’ performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.

Biomechanics Analysis of the Lower Limbs in 20 Male Sprinters Using the International Society of Biomechanics Six-Degrees-of-Freedom Model and the Conventional Gait Model

BACKGROUND This biomechanics study of the lower limbs aimed to compare the use of the International Society of Biomechanics Six-Degrees-of-Freedom (ISB-6DOF) model and the conventional gait model (CGM), formerly known as the Helen Hayes model, in 20 male sprinters who habitually used the forefoot (FF) or rearfoot (RF) strike modes. MATERIAL AND METHODS We used a motion capture system to compare the difference in lower-extremity joint mechanics between sprinters' forefoot or rearfoot strike mode during unplanned sidestepping (UPSS). Twenty elite sprinters participated in a motion capture test under 2 models. Each of the 10 participants were classified as having a habitual forefoot strike mode or rearfoot strike mode during unplanned sidestepping. Joint mechanics and gait parameters were calculated according to the designed movement. RESULTS Comparison of the 2 models showed that the knee joint angles were inconsistent (P<0.05), highlighting the difficulty of the Helen Hayes model in anatomical recognition. The results of the 2 models show that during the unplanned sidestepping, the sprinter using the habitual rearfoot strike mode had a greater load through the knee joint (P<0.05). Sprinters who used the habitual forefoot strike mode experienced greater load through their ankle joints (P<0.05). CONCLUSIONS The findings from this biomechanics study showed that when compared with the ISB-6DoF model, the findings from the CGM were more reproducible for the evaluation of FF and RF strike during unplanned sidestepping.

Monitoring Flexions and Torsions of the Trunk via Gyroscope-Calibrated Capacitive Elastomeric Wearable Sensors

Reliable, easy-to-use, and cost-effective wearable sensors are desirable for continuous measurements of flexions and torsions of the trunk, in order to assess risks and prevent injuries related to body movements in various contexts. Piezo-capacitive stretch sensors, made of dielectric elastomer membranes coated with compliant electrodes, have recently been described as a wearable, lightweight and low-cost technology to monitor body kinematics. An increase of their capacitance upon stretching can be used to sense angular movements. Here, we report on a wearable wireless system that, using two sensing stripes arranged on shoulder straps, can detect flexions and torsions of the trunk, following a simple and fast calibration with a conventional tri-axial gyroscope on board. The piezo-capacitive sensors avoid the errors that would be introduced by continuous sensing with a gyroscope, due to its typical drift. Relative to stereophotogrammetry (non-wearable standard system for motion capture), pure flexions and pure torsions could be detected by the piezo-capacitive sensors with a root mean square error of ~8° and ~12°, respectively, whilst for flexion and torsion components in compound movements, the error was ~13° and ~15°, respectively.

Validation and Assessment of a Posture Measurement System with Magneto-Inertial Measurement Units

Inappropriate posture and the presence of spinal disorders require specific monitoring systems. In clinical settings, posture evaluation is commonly performed with visual observation, electrogoniometers or motion capture systems (MoCaps). Developing a measurement system that can be easily used also in non-structured environments would be highly beneficial for accurate posture monitoring. This work proposes a system based on three magneto-inertial measurement units (MIMU), placed on the backs of seventeen volunteers on the T3, T12 and S1 vertebrae. The reference system used for validation is a stereophotogrammetric motion capture system. The volunteers performed forward bending and sit-to-stand tests. The measured variables for identifying the posture were the kyphosis and the lordosis angles, as well as the range of movement (ROM) of the body segments. The comparison between MIMU and MoCap provided a maximum RMSE of 5.6° for the kyphosis and the lordosis angles. The average lumbo-pelvic contribution during forward bending (41.8 ± 8.6%) and the average lumbar ROM during sit-to-stand (31.8 ± 9.8° for sitting down, 29.6 ± 7.6° for standing up) obtained with the MIMU system agree with the literature. In conclusion, the MIMU system, which is wearable, inexpensive and easy to set up in non-structured environments, has been demonstrated to be effective in posture evaluation.

Capsular ligaments provide a passive stabilizing force to protect the hip against edge loading

AIMS

In the native hip, the hip capsular ligaments tighten at the limits of range of hip motion and may provide a passive stabilizing force to protect the hip against edge loading. In this study we quantified the stabilizing force vectors generated by capsular ligaments at extreme range of motion (ROM), and examined their ability to prevent edge loading.

METHODS

Torque-rotation curves were obtained from nine cadaveric hips to define the rotational restraint contributions of the capsular ligaments in 36 positions. A ligament model was developed to determine the line-of-action and effective moment arms of the medial/lateral iliofemoral, ischiofemoral, and pubofemoral ligaments in all positions. The functioning ligament forces and stiffness were determined at 5 Nm rotational restraint. In each position, the contribution of engaged capsular ligaments to the joint reaction force was used to evaluate the net force vector generated by the capsule.

RESULTS

The medial and lateral arms of the iliofemoral ligament generated the highest inbound force vector in positions combining extension and adduction providing anterior stability. The ischiofemoral ligament generated the highest inbound force in flexion with adduction and internal rotation (FADIR), reducing the risk of posterior dislocation. In this position the hip joint reaction force moved 0.8° inbound per Nm of internal capsular restraint, preventing edge loading.

CONCLUSION

The capsular ligaments contribute to keep the joint force vector inbound from the edge of the acetabulum at extreme ROM. Preservation and appropriate tensioning of these structures following any type of hip surgery may be crucial to minimizing complications related to joint instability. Cite this article: Bone Joint Res 2021;10(9):594-601.

Wearable Detection of Trunk Flexions: Capacitive Elastomeric Sensors Compared to Inertial Sensors

Continuous monitoring of flexions of the trunk via wearable sensors could help various types of workers to reduce risks associated with incorrect postures and movements. Stretchable piezo-capacitive elastomeric sensors based on dielectric elastomers have recently been described as a wearable, lightweight and cost-effective technology to monitor human kinematics. Their stretching causes an increase of capacitance, which can be related to angular movements. Here, we describe a wearable wireless system to detect flexions of the trunk, based on such sensors. In particular, we present: (i) a comparison of different calibration strategies for the capacitive sensors, using either an accelerometer or a gyroscope as an inclinometer; (ii) a comparison of the capacitive sensors’ performance with those of the accelerometer and gyroscope; to that aim, the three types of sensors were evaluated relative to stereophotogrammetry. Compared to the gyroscope, the capacitive sensors showed a higher accuracy. Compared to the accelerometer, their performance was lower when used as quasi-static inclinometers but also higher in case of highly dynamic accelerations. This makes the capacitive sensors attractive as a complementary, rather than alternative, technology to inertial sensors.

Unsupervised Learning for Product Use Activity Recognition: An Exploratory Study of a "Chatty Device"

To create products that are better fit for purpose, manufacturers require new methods for gaining insights into product experience in the wild at scale. “Chatty Factories” is a concept that explores the transformative potential of placing IoT-enabled data-driven systems at the core of design and manufacturing processes, aligned to the Industry 4.0 paradigm. In this paper, we propose a model that enables new forms of agile engineering product development via “chatty” products. Products relay their “experiences” from the consumer world back to designers and product engineers through the mediation provided by embedded sensors, IoT, and data-driven design tools. Our model aims to identify product “experiences” to support the insights into product use. To this end, we create an experiment to: (i) collect sensor data at 100 Hz sampling rate from a “Chatty device” (device with sensors) for six common everyday activities that drive produce experience: standing, walking, sitting, dropping and picking up of the device, placing the device stationary on a side table, and a vibrating surface; (ii) pre-process and manually label the product use activity data; (iii) compare a total of four Unsupervised Machine Learning models (three classic and the fuzzy C-means algorithm) for product use activity recognition for each unique sensor; and (iv) present and discuss our findings. The empirical results demonstrate the feasibility of applying unsupervised machine learning algorithms for clustering product use activity. The highest obtained F-measure is 0.87, and MCC of 0.84, when the Fuzzy C-means algorithm is applied for clustering, outperforming the other three algorithms applied.

Effects of Internal Fixation for Mid-Shaft Clavicle Fractures on Shoulder Kinematics During Humeral Elevations

Background

Mid-shaft clavicle fractures account for 35 to 44% of injuries to the shoulder girdle. There is increasing evidence to support surgical repair, but poor functional outcomes have been reported, and associated factors remain unclear.

Methods

The three-dimensional poses of the shoulder bones during arm elevations were measured in 15 patients treated for mid-shaft clavicle fractures by open reduction and internal fixation, and in 15 healthy controls.

Results and Conclusion

No significant between-side differences were found in the clavicle length after surgery (p > 0.05). The patients showed increased scapular protraction at lower elevation angles and reduced scapular retraction at higher elevation angles during frontal-plane elevations, with significantly reduced clavicle retraction (p < 0.05), with unaltered scapular rotation and tilt. The ranges of the observed changes were reduced to arm elevations at 60° and 90° in the scapular and sagittal planes. Similar changes were also found on the unaffected side, suggesting symmetrical bilateral compensation. The results suggest that shoulder kinematics in multi-plane arm elevations should be monitored for any signs of compromised bone motions following surgical treatment, and that rehabilitative training may be needed on both sides to improve the bilateral movement control of the shoulder complex.

A Two Joint Neck Model to Identify Malposition of the Head Relative to the Thorax

Neck pain is a frequent health complaint. Prolonged protracted malpositions of the head are associated with neck pain and headaches and could be prevented using biofeedback systems. A practical biofeedback system to detect malpositions should be realized with a simple measurement setup. To achieve this, a simple biomechanical model representing head orientation and translation relative to the thorax is introduced. To identify the parameters of this model, anthropometric data were acquired from eight healthy volunteers. In this work we determine (i) the accuracy of the proposed model when the neck length is known, (ii) the dependency of the neck length on the body height, and (iii) the impact of a wrong neck length on the models accuracy. The resulting model is able to describe the motion of the head with a maximum uncertainty of 5 mm only. To achieve this high accuracy the effective neck length must be known a priory. If however, this parameter is assumed to be a linear function of the palpable neck length, the measurement error increases. Still, the resulting accuracy can be sufficient to identify and monitor a protracted malposition of the head relative to the thorax.

Experimental and Modeling Analyses of Human Motion Across the Static Magnetic Field of an MRI Scanner

It is established that human movements in the vicinity of a permanent static magnetic field, such as those in magnetic resonance imaging (MRI) scanners induce electric fields in the human body; this raises potential severe risks of health to radiographers and cleaners exposed routinely to these fields in MRI rooms. The relevant directives and parameters, however, are based on theoretical models, and accurate studies on the simulation of the effects based on human movement data obtained in real conditions are still lacking. Two radiographers and one cleaner, familiar with MRI room activities and these directives, were gait analyzed during the execution of routine job motor tasks at different velocities. Full body motion was recorded in a gait laboratory arranged to reproduce the workspace of a room with an MRI full-body scanner. Body segments were tracked with clusters of at least three markers, from which position and velocity of the centroids were calculated. These were used as input in an established computer physical model able to map the stray field in an MRI room. The spatial peak values of the calculated electric field induced by motion of the head and of the entire body during these tasks, for both the health and sensory effects, were found smaller than the thresholds recommended by the European directives, for both 1.5 T and 3.0 T MRI. These tasks therefore seem to guarantee the safety of MRI room operators according to current professional good practice for exposure risks. Physical modeling and experimental measures of human motion can also support occupational medicine.

The biomechanical role of the lacertus fibrosus of the biceps brachii Muscle

PURPOSE

The lacertus fibrosus (LF) is involved in various surgeries. However, the biomechanical contribution of the LF remains unclear. The aim of this study was to determine the role of the lacertus fibrosus on the elbow and forearm kinematics and on the biceps brachii muscle lever arms.

METHODS

This biomechanical study was performed on seven fresh-frozen upper limbs of cadavers. Elbow flexion, forearm supination, and biceps brachii muscle lever arms were analyzed in the intact conditions (I) and after superficial (R) and deep part (R2) of the lacertus fibrosus release, respectively.

RESULTS

Elbow flexion shows a significant difference (p < 0.0001) between I, R, R2. Abduction/adduction shows a significant difference between I-R (p < 0.0001) and I-R2 (p < 0.0001). Supination does not show a significant difference in mean maximum amplitude, but between 40 and 70%, there are significant differences. There is a significant mean decrease of lever arm in flexion (28%) and supination (50%) after superficial and deep part of the lacertus fibrosus release.

CONCLUSION

The results of this study show that the lacertus fibrosus increases the lever arm during flexion and supination. It limits the flexion and abduction of the elbow and supination of the forearm. Lacertus fibrosus maintains the rhythmicity between the elbow flexion and supination of the forearm.

LEVEL OF EVIDENCE

Basic science study, biomechanics.

Gracilis and semitendinosus moment arm decreased by fascial tissue release after hamstring harvesting surgery: a key parameter to understand the peak torque obtained to a shallow angle of the knee

PURPOSE

Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, but the peak torque angle of hamstring muscles shifted to a shallow angle postoperatively. The goal was to quantify the influence of the myofascial structures on instantaneous moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations.

METHODS

Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each step of the surgery.

RESULTS

No significant difference was demonstrated for instantaneous moment arm of gracilis during anterior cruciate ligament surgery (84% of the maximum intact values; P ≥ 0.05). The first significant semitendinosus moment arm decrease was observed after tendon harvesting (61% of the maximum intact values; p ≤ 0.005). After hamstring harvesting, the maximum and minimum moment arm (both gracilis and semi tendinosus) shifted to a shallow angle and 90°, respectively.

CONCLUSION

Moment arm modifications by paratenons and the loose connective tissue release are essential to understand the peak torque obtained to a shallow angle.

LEVEL OF EVIDENCE

Basic science study, biomechanics.

Low-Rank and Sparse Recovery of Human Gait Data

Due to occlusion or detached markers, information can often be lost while capturing human motion with optical tracking systems. Based on three natural properties of human gait movement, this study presents two different approaches to recover corrupted motion data. These properties are used to define a reconstruction model combining low-rank matrix completion of the measured data with a group-sparsity prior on the marker trajectories mapped in the frequency domain. Unlike most existing approaches, the proposed methodology is fully unsupervised and does not need training data or kinematic information of the user. We evaluated our methods on four different gait datasets with various gap lengths and compared their performance with a state-of-the-art approach using principal component analysis (PCA). Our results showed recovering missing data more precisely, with a reduction of at least 2 mm in mean reconstruction error compared to the literature method. When a small number of marker trajectories is available, our findings showed a reduction of more than 14 mm for the mean reconstruction error compared to the literature approach.

Sex differences in heel pad stiffness during in vivo loading and unloading

Due to conflicting data from previous studies a new methodological approach to evaluate heel pad stiffness and soft tissue deformation has been developed. The purpose of this study was to compare heel pad (HP) stiffness in both limbs between males and females during a dynamic unloading and loading activity. Ten males and 10 females volunteered to perform three dynamic trials to unload and load the HP. The dynamic protocol consisted of three continuous phases: foot flat (baseline phase), bilateral heel raise (unloading phase) and foot flat (loading phase) with each phase lasting two seconds. Six retroreflective markers (3 mm) were attached to the skin of the left and right heels using a customised marker set. Three‐dimensional motion analysis cameras synchronised with force plates collected the kinematic and kinetic data throughout the trials. Three‐way repeated measures ANOVA together with a Bonferroni post hoc test were applied to the stiffness and marker displacement datasets. On average, HP stiffness was higher in males than females during the loading and unloading phases. ANOVA results revealed no significant differences for the stiffness and displacement outputs with respect to sex, sidedness or phase interactions (p > .05) in the X, Y and Z directions. Irrespective of direction, there were significant differences in stiffness between the baseline and unloading conditions (p < .001) but no significant differences between the baseline and loaded conditions (p = 1.000). Post hoc analyses for the marker displacement showed significant differences between phases for the X and Z directions (p < .032) but no significant differences in the Y direction (p > .116). Finally, females portrayed lower levels of mean HP stiffness whereas males had stiffer heels particularly in the vertical direction (Z) when the HP was both unloaded and loaded. High HP stiffness values and very small marker displacements could be valuable indicators for the risk of pathological foot conditions.

Quantification of Triple Single-Leg Hop Test Temporospatial Parameters: A Validated Method using Body-Worn Sensors for Functional Evaluation after Knee Injury

Lower extremity kinematic alterations associated with sport-related knee injuries may contribute to an unsuccessful return to sport or early-onset post-traumatic osteoarthritis. Also, without access to sophisticated motion-capture systems, temporospatial monitoring of horizontal hop tests during clinical assessments is limited. By applying an alternative measurement system of two inertial measurement units (IMUs) per limb, we obtained and validated flying/landing times and hop distances of triple single-leg hop (TSLH) test against motion-capture cameras, assessed these temporospatial parameters amongst injured and uninjured groups, and investigated their association with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Using kinematic features of IMU recordings, strap-down integration, and velocity correction techniques, temporospatial parameters were validated for 10 able-bodied participants and compared between 22 youth with sport-related knee injuries and 10 uninjured youth. With median (interquartile range) errors less than 10(16) ms for flying/landing times, and less than 4.4(5.6)% and 2.4(3.0)% of reference values for individual hops and total TSLH progression, differences between hopping biomechanics of study groups were highlighted. For injured participants, second flying time and all hop distances demonstrated moderate to strong correlations with KOOS Symptom and Function in Daily Living scores. Detailed temporospatial monitoring of hop tests is feasible using the proposed IMUs system.

Sensor-to-Segment Calibration Methodologies for Lower-Body Kinematic Analysis with Inertial Sensors: A Systematic Review

Kinematic analysis is indispensable to understanding and characterizing human locomotion. Thanks to the development of inertial sensors based on microelectronics systems, human kinematic analysis in an ecological environment is made possible. An important issue in human kinematic analyses with inertial sensors is the necessity of defining the orientation of the inertial sensor coordinate system relative to its underlying segment coordinate system, which is referred to sensor-to-segment calibration. Over the last decade, we have seen an increase of proposals for this purpose. The aim of this review is to highlight the different proposals made for lower-body segments. Three different databases were screened: PubMed, Science Direct and IEEE Xplore. One reviewer performed the selection of the different studies and data extraction. Fifty-five studies were included. Four different types of calibration method could be identified in the articles: the manual, static, functional, and anatomical methods. The mathematical approach to obtain the segment axis and the calibration evaluation were extracted from the selected articles. Given the number of propositions and the diversity of references used to evaluate the methods, it is difficult today to form a conclusion about the most suitable. To conclude, comparative studies are required to validate calibration methods in different circumstances.

Kinect and wearable inertial sensors for motor rehabilitation programs at home: state of the art and an experimental comparison

BACKGROUND

Emerging sensing and communication technologies are contributing to the development of many motor rehabilitation programs outside the standard healthcare facilities. Nowadays, motor rehabilitation exercises can be easily performed and monitored even at home by a variety of motion-tracking systems. These are cheap, reliable, easy-to-use, and allow also remote configuration and control of the rehabilitation programs. The two most promising technologies for home-based motor rehabilitation programs are inertial wearable sensors and video-based motion capture systems.

METHODS

In this paper, after a thorough review of the relevant literature, an original experimental analysis is reported for two corresponding commercially available solutions, a wearable inertial measurement unit and the Kinect, respectively. For the former, a number of different algorithms for rigid body pose estimation from sensor data were also tested. Both systems were compared with the measurements obtained with state-of-the-art marker-based stereophotogrammetric motion analysis, taken as a gold-standard, and also evaluated outside the lab in a home environment.

RESULTS

The results in the laboratory setting showed similarly good performance for the elementary large motion exercises, with both systems having errors in the 3-8 degree range. Usability and other possible limitations were also assessed during utilization at home, which revealed additional advantages and drawbacks for the two systems.

CONCLUSIONS

The two evaluated systems use different technology and algorithms, but have similar performance in terms of human motion tracking. Therefore, both can be adopted for monitoring home-based rehabilitation programs, taking adequate precautions however for operation, user instructions and interpretation of the results.

3D Tracking of Human Motion Using Visual Skeletonization and Stereoscopic Vision

The design of markerless systems to reconstruct human motion in a timely, unobtrusive and externally valid manner is still an open challenge. Artificial intelligence algorithms based on automatic landmarks identification on video images opened to a new approach, potentially e-viable with low-cost hardware. OpenPose is a library that t using a two-branch convolutional neural network allows for the recognition of skeletons in the scene. Although OpenPose-based solutions are spreading, their metrological performances relative to video setup are still largely unexplored. This paper aimed at validating a two-cameras OpenPose-based markerless system for gait analysis, considering its accuracy relative to three factors: cameras' relative distance, gait direction and video resolution. Two volunteers performed a walking test within a gait analysis laboratory. A marker-based optical motion capture system was taken as a reference. Procedures involved: calibration of the stereoscopic system; acquisition of video recordings, simultaneously with the reference marker-based system; video processing within OpenPose to extract the subject's skeleton; videos synchronization; triangulation of the skeletons in the two videos to obtain the 3D coordinates of the joints. Two set of parameters were considered for the accuracy assessment: errors in trajectory reconstruction and error in selected gait space-temporal parameters (step length, swing and stance time). The lowest error in trajectories (~20 mm) was obtained with cameras 1.8 m apart, highest resolution and straight gait, and the highest (~60 mm) with the 1.0 m, low resolution and diagonal gait configuration. The OpenPose-based system tended to underestimate step length of about 1.5 cm, while no systematic biases were found for swing/stance time. Step length significantly changed according to gait direction (p = 0.008), camera distance (p = 0.020), and resolution (p < 0.001). Among stance and swing times, the lowest errors (0.02 and 0.05 s for stance and swing, respectively) were obtained with the 1 m, highest resolution and straight gait configuration. These findings confirm the feasibility of tracking kinematics and gait parameters of a single subject in a 3D space using two low-cost webcams and the OpenPose engine. In particular, the maximization of cameras distance and video resolution enabled to achieve the highest metrological performances.

A Comparison of the Conventional PiG Marker Method Versus a Cluster-Based Model when recording Gait Kinematics in Trans-Tibial Prosthesis Users and the Implications for Future IMU Gait Analysis

Validation testing is a necessary step for inertial measurement unit (IMU) motion analysis for research and clinical use. Optical tracking systems utilize marker models which must be precise in measurement and mitigate skin artifacts. Prosthesis wearers present challenges to optical tracking marker model choice. Seven participants were recruited and underwent simultaneous motion capture from two marker sets; Plug in Gait (PiG) and the Strathclyde Cluster Model (SCM). Variability of joint kinematics within and between subjects was evaluated. Variability was higher for PiG than SCM for all parameters. The within-subjects variability as reported by the average standard deviation (SD), was below 5.6° for all rotations of the hip on the prosthesis side for all participants for both methods, with an average of 2.1° for PiG and 2.5° for SCM. Statistically significant differences in joint parameters caused by a change in the protocol were evident in the sagittal plane (p < 0.05) on the amputated side. Trans-tibial gait analysis was best achieved by use of the SCM. The SCM protocol appeared to provide kinematic measurements with a smaller variability than that of the PiG. Validation studies for prosthesis wearer populations must reconsider the marker protocol for gold standard comparisons with IMUs.

A Canine Gait Analysis Protocol for Back Movement Assessment in German Shepherd Dogs

Objective—To design and test a motion analysis protocol for the gait analysis of adult German Shepherd (GS) dogs with a focus in the analyses of their back movements. Animals—Eight clinically healthy adult large-sized GS dogs (age, 4 ± 1.3 years; weight, 38.8 ± 4.2 kg). Procedures—A six-camera stereo-photogrammetric system and two force platforms were used for data acquisition. Experimental acquisition sessions consisted of static and gait trials. During gait trials, each dog walked along a 6 m long walkway at self-selected speed and a total of six gait cycles were recorded. Results—Grand mean and standard deviation of ground reaction forces of fore and hind limbs are reported. Spatial-temporal parameters averaged over gait cycles and subjects, their mean, standard deviation and coefficient of variance are analyzed. Joint kinematics for the hip, stifle and tarsal joints and their average range of motion (ROM) values, and their 95% Confidence Interval (CI) values of kinematics curves are reported. Conclusions and Clinical Relevance—This study provides normative data of healthy GS dogs to form a preliminary basis in the analysis of the spatial-temporal parameters, kinematics and kinetics during quadrupedal stance posture and gait. Also, a new back movement protocol enabling a multi-segment back model is provided. Results show that the proposed gait analysis protocol may become a useful and objective tool for the evaluation of canine treatment with special focus on the back movement.

The habitual motion path theory: Evidence from cartilage volume reductions in the knee joint after 75 minutes of running

The habitual motion path theory predicts that humans tend to maintain their habitual motion path (HMP) during locomotion. The HMP is the path of least resistance of the joints defined by an individual's musculoskeletal anatomy and passive tissue properties. Here we tested whether participants with higher HMP deviation and whether using footwear that increases HMP deviation during running show higher reductions of knee joint articular cartilage volume after 75 minutes of running. We quantified knee joint articular cartilage volumes before and after the run using a 3.0-Tesla MRI. We performed a 3D movement analysis of runners in order to quantify their HMP from a two-legged squat motion and the deviation from the HMP when running in different footwear conditions. We found significantly more cartilage volume reductions in the medial knee compartment and patella for participants with higher HMP deviation. We also found higher cartilage volume reductions on the medial tibia when runners wore a shoe that maximized their HMP deviation compared with the shoe that minmized their HMP deviation. Runners might benefit from reducing their HMP deviation and from selecting footwear by quantifying HMP deviation in order to minimize joint cartilage loading in sub-areas of the knee.

Inter-laboratory and inter-operator reproducibility in gait analysis measurements in pediatric subjects

The intra-subject, the inter-operator, and the inter-laboratory variabilities are the main sources of uncertainties in gait analysis, and their effects have been partially described in the literature for adult populations. This study aimed to extend the repeatability and reproducibility analysis to a pediatric population, accounting for the effects induced by the intra-subject variations, the measurement setup, the marker set configuration, and the involved operators in placing markers and EMG electrodes. We evaluated kinematic, kinetic and EMG outputs collected from gait analyses performed on two healthy children in two laboratories, by two operators, and with two marker placement protocols. The two involved centers previously defined a common acquisition procedure based on their routine pipelines. The similarity of kinematic, kinetic, and EMG curves were evaluated by means of the coefficients of the Linear Fit Method, and the Mean Absolute Variability with and without the offset among curves. The inter-operator variability was found to be the main contribution to the overall reproducibility of kinematic and kinetic gait data. On the contrary, the main contribution to the variability of the EMG signals was the intra-subject repeatability that is due to the physiological stride to stride muscle activation variability.

Validation of Novel Relative Orientation and Inertial Sensor-to-Segment Alignment Algorithms for Estimating 3D Hip Joint Angles

Wearable sensor-based algorithms for estimating joint angles have seen great improvements in recent years. While the knee joint has garnered most of the attention in this area, algorithms for estimating hip joint angles are less available. Herein, we propose and validate a novel algorithm for this purpose with innovations in sensor-to-sensor orientation and sensor-to-segment alignment. The proposed approach is robust to sensor placement and does not require specific calibration motions. The accuracy of the proposed approach is established relative to optical motion capture and compared to existing methods for estimating relative orientation, hip joint angles, and range of motion (ROM) during a task designed to exercise the full hip range of motion (ROM) and fast walking using root mean square error (RMSE) and regression analysis. The RMSE of the proposed approach was less than that for existing methods when estimating sensor orientation ( 12 . 32 ∘ and 11 . 82 ∘ vs. 24 . 61 ∘ and 23 . 76 ∘ ) and flexion/extension joint angles ( 7 . 88 ∘ and 8 . 62 ∘ vs. 14 . 14 ∘ and 15 . 64 ∘ ). Also, ROM estimation error was less than 2 . 2 ∘ during the walking trial using the proposed method. These results suggest the proposed approach presents an improvement to existing methods and provides a promising technique for remote monitoring of hip joint angles.

Kinematic Evaluation of the GMK Sphere Implant During Gait Activities: A Dynamic Videofluoroscopy Study

Joint stability is a primary concern in total knee joint replacement. The GMK Sphere prosthesis was specifically designed to provide medial compartment anterior-posterior (A-P) stability, while permitting rotational freedom of the joint through a flat lateral tibial surface. The objective of this study was to establish the changes in joint kinematics introduced by the GMK Sphere prosthesis during gait activities in comparison to conventional posterior-stabilized (PS) fixed-bearing and ultra-congruent (UC) mobile-bearing geometries. The A-P translation and internal/external rotation of three cohorts, each with 10 good outcome subjects (2.9 ± 1.6 years postop), with a GMK Sphere, GMK PS or GMK UC implant were analysed throughout complete cycles of gait activities using dynamic videofluoroscopy. The GMK Sphere showed the smallest range of medial compartment A-P translation for level walking, downhill walking, and stair descent (3.6 ± 0.9 mm, 3.1 ± 0.8 mm, 3.9 ± 1.3 mm), followed by the GMK UC (5.7 ± 1.0 mm, 8.0 ± 1.7 mm, 8.7 ± 1.9 mm) and the GMK PS (10.3 ± 2.2 mm, 10.1 ± 2.6 mm, 11.6 ± 1.6 mm) geometries. The GMK Sphere exhibited the largest range of lateral compartment A-P translation (12.1 ± 2.2 mm), and the largest range of tibial internal/external rotation (13.2 ± 2.2°), both during stair descent. This study has shown that the GMK Sphere clearly restricts A-P motion of the medial condyle during gait activities while still allowing a large range of axial rotation. The additional comparison against the conventional GMK PS and UC geometries, not only demonstrates that implant geometry is a key factor in governing tibio-femoral kinematics, but also that the geometry itself probably plays a more dominant role for joint movement than the type of gait activity. © 2019 The Authors. Journal of Orthopaedic Research^® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2337-2347, 2019.

Fast, Flexible Closed-Loop Feedback: Tracking Movement in "Real-Millisecond-Time"

One of the principal functions of the brain is to control movement and rapidly adapt behavior to a changing external environment. Over the last decades our ability to monitor activity in the brain, manipulate it while also manipulating the environment the animal moves through, has been tackled with increasing sophistication. However, our ability to track the movement of the animal in real time has not kept pace. Here, we use a dynamic vision sensor (DVS) based event-driven neuromorphic camera system to implement real-time, low-latency tracking of a single whisker that mice can move at ∼25 Hz. The customized DVS system described here converts whisker motion into a series of events that can be used to estimate the position of the whisker and to trigger a position-based output interactively within 2 ms. This neuromorphic chip-based closed-loop system provides feedback rapidly and flexibly. With this system, it becomes possible to use the movement of whiskers or in principal, movement of any part of the body to reward, punish, in a rapidly reconfigurable way. These methods can be used to manipulate behavior, and the neural circuits that help animals adapt to changing values of a sequence of motor actions.

Upper limb joint kinematics using wearable magnetic and inertial measurement units: an anatomical calibration procedure based on bony landmark identification

The estimate of a consistent and clinically meaningful joint kinematics using wearable inertial and magnetic sensors requires a sensor-to-segment coordinate system calibration. State-of-the-art calibration procedures for the upper limb are based on functional movements and/or pre-determined postures, which are difficult to implement in subjects that have impaired mobility or are bedridden in acute units. The aim of this study was to develop and validate an alternative calibration procedure based on the direct identification of palpable anatomical landmarks (ALs) for an inertial and magnetic sensor-based upper limb movement analysis protocol. The proposed calibration procedure provides an estimate of three-dimensional shoulder/elbow angular kinematics and the linear trajectory of the wrist according to the standards proposed by the International Society of Biomechanics. The validity of the method was assessed against a camera-based optoelectronic system during uniaxial joint rotations and a reach-to-grasp task. Joint angular kinematics was found as characterised by a low-biased range of motion (<-2.6°), a low root mean square deviation (RMSD) (<4.4°) and a high waveform similarity coefficient (R² > 0.995) with respect to the gold standard. Except for the cranio-caudal direction, the linear trajectory of the wrist was characterised by a low-biased range of motion (<11 mm) together with a low RMSD (8 mm) and high waveform similarity (R² > 0.968). The proposed method enabled the estimation of reliable joint kinematics without requiring any active involvement of the patient during the calibration procedure, complying with the metrological standards and requirements of clinical movement analysis.

The Motion of Body Center of Mass During Walking: A Review Oriented to Clinical Applications

Human walking is usually conceived as the cyclic rotation of the limbs. The goal of lower-limb movements, however, is the forward translation of the body system, which can be mechanically represented by its center of mass (CoM). Lower limbs act as struts of an inverted pendulum, allowing minimization of muscle work, from infancy to old age. The plantar flexors of the trailing limbs have been identified as the main engines of CoM propulsion. Motion of the CoM can be investigated through refined techniques, but research has been focused on the fields of human and animal physiology rather than clinical medicine. Alterations in CoM motion could reveal motor impairments that are not detectable by clinical observation. The study of the three-dimensional trajectory of the CoM motion represents a clinical frontier. After adjusting for displacement due to the average forward speed, the trajectory assumes a figure-eight shape (dubbed the “bow-tie”) with a perimeter about 18 cm long. Its lateral size decreases with walking velocity, thus ensuring dynamic stability. Lateral redirection appears as a critical phase of the step, requiring precise muscle sequencing. The shape and size of the “bow-tie” as functions of dynamically equivalent velocities do not change from child to adulthood, despite anatomical growth. The trajectory of the CoM thus appears to be a promising summary index of both balance and the neural maturation of walking. In asymmetric gaits, the affected lower limb avoids muscle work by pivoting almost passively, but extra work is required from the unaffected side during the next step, in order to keep the body system in motion. Generally, the average work to transport the CoM across a stride remains normal. In more demanding conditions, such as walking faster or uphill, the affected limb can actually provide more work; however, the unaffected limb also provides more work and asymmetry between the steps persists. This learned or acquired asymmetry is a formerly unsuspected challenge to rehabilitation attempts to restore symmetry. Techniques of selective loading of the affected side, which include constraining the motion of the unaffected limb or forcing the use of the affected limb on split-belt treadmills which impose a different velocity and power to either limb, are now under scrutiny.

IMU-based sensor-to-segment multiple calibration for upper limb joint angle measurement-a proof of concept

A lot of attention has been paid to wearable inertial sensors regarded as an alternative solution for outdoor human motion tracking. Relevant joint angles can only be calculated from anatomical orientations, but they are negatively impacted by soft tissue artifact (STA) defined as skin motion with respect to the underlying bone; the accuracy of measured joint angle during movement is affected by the ongoing misalignment of the sensor. In this work, a new sensor-to-segment calibration using inertial measurement units is proposed. Inspired by the multiple calibration for a cluster of skin markers, it consists in performing first multiple static postures of the upper limb in all anatomical planes. The movements that affect sensor alignment are identified then alignment differences between sensors and segment frames are calculated for each posture and linearly interpolated. Experimental measurements were carried out on a mechanical model and on a subject who performed different movements of right elbow and shoulder. Multiple calibration showed significant improvement in joint angle measurement on the mechanical model as well as on human joint angle comparing to those obtained from attached sensors after technical calibration. During shoulder internal-external rotation, the maximal error value decreased more than 50% after correction. Graphical abstract Elbow flexion-extension joint angle values obtained from IMUs are well-corrected after applying multiple calibration procedure. Though shoulder internal-external rotation joint angle is more affected by soft tissue artifact, multiple calibration procedure improves the angle values obtained from IMUs.

Agreement Analysis between Vive and Vicon Systems to Monitor Lumbar Postural Changes

Immersive virtual reality has recently developed into a readily available system that allows for full-body tracking. Can this affordable system be used for component tracking to advance or replace expensive kinematic systems for motion analysis in the clinic? The aim of this study was to assess the accuracy of position and orientation measures from Vive wireless body trackers when compared to Vicon optoelectronic tracked markers attached to (1) a robot simulating trunk flexion and rotation by repeatedly moving to know locations, and (2) healthy adults playing virtual reality games necessitating significant trunk displacements. The comparison of both systems showed component tracking with Vive trackers is accurate within 0.68 ± 0.32 cm translationally and 1.64 ± 0.18° rotationally when compared with a three-dimensional motion capture system. No significant differences between Vive trackers and Vicon systems were found suggesting the Vive wireless sensors can be used to accurately track joint motion for clinical and research data.

Concurrent validity of lower extremity kinematics and jump characteristics captured in pre-school children by a markerless 3D motion capture system

Background

Investigations into the possible associations between early in life motor function and later in life musculoskeletal health, will require easily obtainable, valid, and reliable measures of gross motor function and kinematics. Marker-based motion capture systems provide reasonably valid and reliable measures, but recordings are restricted to expensive lab environments. Markerless motion capture systems can provide measures of gross motor function and kinematics outside of lab environments and with minimal interference to the subjects being investigated. It is, however, unknown if these measures are sufficiently valid and reliable in young children to warrant further use. This study aims to document the concurrent validity of a markerless motion capture system: “The Captury.”

Method

Measures of gross motor function and lower extremity kinematics from 14 preschool children (age between three and 6 years) performing a series of squats and standing broad jumps were recorded by a marker-based (Vicon) and a markerless (The Captury) motion capture system simultaneously, in December 2015. Measurement differences between the two systems were examined for the following variables: jump length, jump height, hip flexion, knee flexion, ankle dorsi flexion, knee varus, knee to hip separation distance ratio (KHR), ankle to hip separation distance ratio (AHR), frontal plane projection angle, frontal plane knee angle (FPKA), and frontal plane knee deviation (FPKD). Measurement differences between the systems were expressed in terms of root mean square errors, mean differences, limits of agreement (LOA), and intraclass correlations of absolute agreement (ICC (2,1) A) and consistency of agreement.

Results

Measurement differences between the two systems varied depending on the variables. Agreement and reliability ranged from acceptable for e.g. jump height [LOA: − 3.8 cm to 2.2 cm; ICC (2,1) A: 0.91] to unacceptable for knee varus [LOA: − 33° to 19°; ICC (2,1) A: 0.29].

Conclusions

The measurements by the markerless motion capture system “The Captury” cannot be considered interchangeable with the Vicon measures, but our results suggest that this system can produce estimates of jump length, jump height, KHR, AHR, knee flexion, FPKA, and FPKD, with acceptable levels of agreement and reliability. These variables are promising for use in future research but require further investigation of their clinimetric properties.

Estimation of 3D Knee Joint Angles during Cycling Using Inertial Sensors: Accuracy of a Novel Sensor-to-Segment Calibration Procedure Based on Pedaling Motion

This paper presents a novel sensor-to-segment calibration procedure for inertial sensor-based knee joint kinematics analysis during cycling. This procedure was designed to be feasible in-field, autonomously, and without any external operator or device. It combines a static standing up posture and a pedaling task. The main goal of this study was to assess the accuracy of the new sensor-to-segment calibration method (denoted as the 'cycling' method) by calculating errors in terms of body-segment orientations and 3D knee joint angles using inertial measurement unit (IMU)-based and optoelectronic-based motion capture. To do so, 14 participants were evaluated during pedaling motion at a workload of 100 W, which enabled comparisons of the cycling method with conventional calibration methods commonly employed in gait analysis. The accuracy of the cycling method was comparable to that of other methods concerning the knee flexion/extension angle, and did not exceed 3.8°. However, the cycling method presented the smallest errors for knee internal/external rotation (6.65 ± 1.94°) and abduction/adduction (5.92 ± 2.85°). This study demonstrated that a calibration method based on the completion of a pedaling task combined with a standing posture significantly improved the accuracy of 3D knee joint angle measurement when applied to cycling analysis.