Body size and lower limb posture during walking in humans

Macroscopic differences in adult human femora are linked to body mass index

Bone functional adaptation is routinely invoked to interpret skeletal morphology despite ongoing debate regarding the limits of the bone response to mechanical stimuli. The wide variation in human body mass presents an opportunity to explore the relationship between mechanical load and skeletal response in weight-bearing elements. Here, we examine variation in femoral macroscopic morphology as a function of body mass index (BMI), which is used as a metric of load history. A sample of 80 femora (40 female; 40 male) from recent modern humans was selected from the Texas State University Donated Skeletal Collection. Femora were imaged using x-ray computed tomography (voxel size ~0.5 mm), and segmented to produce surface models. Landmark-based geometric morphometric analyses based on the Coherent Point Drift algorithm were conducted to quantify shape. Principal components analyses were used to summarize shape variation, and component scores were regressed on BMI. Within the male sample, increased BMI was associated with a mediolaterally expanded femoral shaft, as well as increased neck-shaft angle and decreased femoral neck anteversion angle. No statistically significant relationships between shape and BMI were found in the female sample. While mechanical stimulus has traditionally been applied to changes in long bong diaphyseal shape it appears that bone functional adaptation may also result in fundamental changes in the shape of skeletal elements.

Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis

Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We examined spatiotemporal gait parameters, including step length and cadence, in 25 individuals with UTFA (functional level K3 or K4, all non-vascular amputations) while they walked on a split-belt instrumented treadmill at eight speeds. Hierarchical cluster analysis (HCA) was used to identify clusters with homogeneous gait patterns based on the relationships between step length and cadence. Furthermore, after cluster formation, post-hoc analyses were performed to compare the spatiotemporal parameters and demographic data among the clusters. HCA identified three homogeneous gait pattern clusters, suggesting that individuals with UTFA have several gait patterns. Further, we found significant differences in the participants' body height, sex ratio, and their prosthetic knee component among the clusters. Therefore, gait rehabilitation should be individualized based on body size and prosthetic prescription.

Gait Phase Detection in Walking and Stairs Using Machine Learning

Activity and gait phase recognition algorithms are used in powered motion assistive devices to inform control of motorized components. The objective of this study was to develop a machine learning-based algorithm using inertial measurement data from the thigh and shank to simultaneously detect activity and gait phase (stance, swing) in real-world walking, stair ascent, and stair descent, with the intent of such an algorithm to be used in the control of a motion assistive device local to the knee. Using data from 80 participants, two decision tree and ten long short-term memory (LSTM) models that each used different feature sets and input data were tested and evaluated using a novel performance metric: proportion of perfectly classified strides (PPCS). Separate models were developed to classify i) both activity and gait phase simultaneously (one model predicting six states), and ii) activity-specific models (three individual binary classifiers predicting stance/swing phases). The superior activity-specific model had an accuracy of 98.0% and PPCS of 55.7%. The superior six-phase model used filtered inertial measurement data as its features and a median filter on its predictions and had an accuracy of 92.1% and PPCS of 22.9%. Pooling stance and swing phases from all activities and treating this model as a binary classifier, this model had an accuracy of 97.1%, which may be acceptable for real-world lower limb exoskeleton control if only stance and swing gait phases must be detected.

Acquisition of Lower-Limb Motion Characteristics with a Single Inertial Measurement Unit—Validation for Use in Physiotherapy

In physiotherapy, there is still a lack of practical measurement options to track the progress of therapy or rehabilitation following injuries to the lower limbs objectively and reproducibly yet simply and with minimal effort and time. We aim at filling this gap with the design of an IMU (inertial measurement unit) system with only one sensor placed on the tibia edge. In our study, the IMU system evaluated a set of 10 motion tests by a score value for each test and stored them in a database for a more reliable longitudinal assessment of the progress. The sensor analyzed the different motion patterns and obtained characteristic physiological parameters, such as angle ranges, and spatial and angular displacements, such as knee valgus under load. The scores represent the patient’s coordination, stability, strength and speed. To validate the IMU system, these scores were compared to corresponding values from a simultaneously recorded marker-based 3D video motion analysis of the measurements from five healthy volunteers. Score differences between the two systems were almost always within 1–3 degrees for angle measurements. Timing-related measurements were nearly completely identical. The tests on the valgus stability of the knee showed equally small deviations but should nevertheless be repeated with patients, because the healthy subjects showed no signs of instability.

Clothing condition does not affect meaningful clinical interpretation in markerless motion capture

Markerless motion capture allows whole-body movements to be captured without the need for physical markers to be placed on the body. This enables motion capture analyses to be conducted in more ecologically valid environments. However, the influences of varied clothing on video-based markerless motion capture assessments remain largely unexplored. This study investigated two types of clothing conditions, "Sport" (gym shirt and shorts) and "Street" (unrestricted casual clothing), on gait parameters during overground walking by 29 participants at self-selected speeds using markerless motion capture. Segment lengths, gait spatiotemporal parameters, and lower-limb kinematics were compared between the two clothing conditions. Mean differences in segment length for the forearm, upper arm, thigh, and shank between clothing conditions ranged from 0.2 cm for the forearm to 0.9 cm for the thigh (p < 0.05 for thigh and shank) but below typical marker placement errors (1 - 2 cm). Seven out of 9 gait spatiotemporal parameters demonstrated statistically significant differences between clothing conditions (p < 0.05), however, these differences were approximately ten times smaller than minimal detectable changes in movement-related pathologies including multiple sclerosis and cerebral palsy. Hip, knee, and ankle joint angle root-mean-square deviation values averaged 2.6° and were comparable to previously reported average inter-session variability for this markerless system (2.8°). The results indicate that clothing, a potential limiting factor in markerless motion capture performance, would negligibly alter meaningful clinical interpretations under the conditions investigated.

The Implication of Pathway Turn and Task Condition on Gait Quantified Using SmartWalk: Changes With Age and Parkinson's Disease With Relevance to Postural Strategy and Risk of Fall

One's gait can be affected by aging, pathway with turns, task demands, etc., causing changes in gait-related indices and knee flexion (influencing posture). Walking on pathways with turns threatens stability, affecting one's gait-related indices and posture. The ability to overcome such deficits is compromised with age and neurological disorders, e.g., Parkinson's Disease (PD) leading to falls. Also, task demands imposed by single and dual-task (e.g., counting backward while walking) conditions affect the gait of individuals using different postural strategies varying with age and neurological disorder. Existing research has investigated either the effect of the pathway with turn or task condition on one's gait. However, none (to our knowledge) have explored the differentiated implications of the pathway with turn and task conditions on one's gait-related indices and knee flexion while walking. Our study had two phases with 30 participants. Phase 1 had healthy adults (young and old) and Phase 2 had age and gender-matched healthy elderly and individuals with Parkinson's disease (PD) who walked on pathways having turns under single and dual-task conditions. We analysed gait in terms of (i) gait-related indices (Phases 1 and 2) and (ii) knee flexion (Phase 2). Also, we analysed one's counting performance during dual task. One's gait-related indices and knee flexion were measured using a portable gait quantifier. The aim was to (i)understand whether both pathways with turn and task conditions are equally effective in affecting the gait of (a)individuals of varying ages and (b) gender-matched healthy older adults and individuals with PD, (ii)study variations of knee joint angles while walking on pathways having turns (under different task conditions) in terms of its clinical relevance, and (iii) explore the implication of pathway with turn on counting performance (with relevance to postural strategy) with varying age and PD. Results indicated that for the younger group, the task condition caused statistical variations in gait-related indices. For the older group, both pathways with turn and task conditions had statistical implications on gait-related indices. Additionally, individuals with PD demonstrated a higher variation in knee flexion than their healthy counterparts. Again, pathways with varying turns elicited variations in counting performance indicating different postural strategies being employed by the three groups.

Using Machine Learning Algorithms for Identifying Gait Parameters Suitable to Evaluate Subtle Changes in Gait in People with Multiple Sclerosis

In multiple sclerosis (MS), gait impairment is one of the most prominent symptoms. For a sensitive assessment of pathological gait patterns, a comprehensive analysis and processing of several gait analysis systems is necessary. The objective of this work was to determine the best diagnostic gait system (DIERS pedogait, GAITRite system, and Mobility Lab) using six machine learning algorithms for the differentiation between people with multiple sclerosis (pwMS) and healthy controls, between pwMS with and without fatigue and between pwMS with mild and moderate impairment. The data of the three gait systems were assessed on 54 pwMS and 38 healthy controls. Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, and Support Vector Machines (SVM) with linear, radial basis function (rbf) and polynomial kernel were applied for the detection of subtle walking changes. The best performance for a healthy-sick classification was achieved on the DIERS data with a SVM rbf kernel (κ = 0.49 ± 0.11). For differentiating between pwMS with mild and moderate disability, the GAITRite data with the SVM linear kernel (κ = 0.61 ± 0.06) showed the best performance. This study demonstrates that machine learning methods are suitable for identifying pathologic gait patterns in early MS.

Scaling and relative size of the human, nonhuman ape, and baboon calcaneus

Among human and nonhuman apes, calcaneal morphology exhibits significant variation that has been related to locomotor behavior. Due to its role in weight-bearing, however, both body size and locomotion may impact calcaneal morphology. Determining how calcaneal morphologies vary as a function of body size is thus vital to understanding calcaneal functional adaptation. Here, we study calcaneus allometry and relative size in humans (n = 120) and nonhuman primates (n = 278), analyzing these relationships in light of known locomotor behaviors. Twelve linear measures and three articular facet surface areas were collected on calcaneus surface models. Body mass was estimated using femoral head superoinferior breadth. Relationships between calcaneal dimensions and estimated body mass were analyzed across the sample using phylogenetic least squares regression analyses (PGLS). Differences between humans and pooled nonhuman primates were tested using RMA ANCOVAs. Among (and within) genera residual differences from both PGLS regressions and isometry were analyzed using ANOVAs with post hoc multiple comparison tests. The relationships between all but two calcaneus dimensions and estimated body mass exhibit phylogenetic signal at the smallest taxonomic scale. This signal disappears when reanalyzed at the genus level. Calcaneal morphology varies relative to both body size and locomotor behavior. Humans have larger calcanei for estimated body mass relative to nonhuman primates as a potential adaptation for bipedalism. More terrestrial taxa exhibit longer calcaneal tubers for body mass, increasing the triceps surae lever arm. Among nonhuman great apes, more arboreal taxa have larger cuboid facet surface areas for body mass, increasing calcaneocuboid mobility.

Quasi-stiffness of the knee joint is influenced by walking on a destabilising terrain

BACKGROUND

Predictive models have been devised to estimate the necessary quasi-stiffness that a transfemoral prosthesis should be set to aligning the body and gait parameters of the user. Current recommendations exist only for walking over level ground. This study aimed to ascertain whether walking across destabilising terrain influences the quasi-stiffness of the knee joint thus influencing prosthetic engineering.

METHODS

Ten healthy males (age: 25.1 ± 2.5 years; mean ± sd, height: 1.78 ± 0.05 m, weight: 84.40 ± 11.02 kg) performed 14 gait trials. Seven trials were conducted over even ground and seven over 20 mm ballast. Three-dimensional motion capture and ground reaction force were collected. Paired samples t-tests and Wilcoxon signed ranked test compared variables including; quasi-stiffness, gait speed, stride length and stride width.

RESULTS

Quasi-stiffness (d = 0.562, P = 0.001) and stride width (d = 0.909, P < 0.001) were significantly greater in the destabilising terrain condition. Gait speed (r = -0.731, P = 0.001) was significantly greater in the control condition. No significant difference was seen in stride length (d = 0.583, P = 0.016).

CONCLUSIONS

An increase in quasi-stiffness when walking across destabilising terrain was attributed to a magnified shock absorption mechanism, facilitating an increased flexion angle during the stance phase. This causes a lower centre of mass resulting in the musculoskeletal system having to produce a greater knee extensor moment to prevent the knee collapsing. Therefore, transfemoral prostheses should be tuned to apply increased extension moments if ambulation is to occur on a destabilising terrain.

Obstacle-Crossing Task-Related Usual Gait Patterns of Older Adults Differentiating Falls and Gait Ability

Obstacle crossing, such as stepping over a curb, exerts additional demands on balance control, and therefore the study of usual-pace gait patterns associated with obstacle-crossing performance may provide additional insight into understanding falls and deterioration of gait in older adults. Participants included 432 adults aged 60-96 years (218 women). Participants who failed the obstacle-crossing task (n = 181) walked slower with smaller knee range of motion than participants who successfully completed the obstacle-crossing task (all ps < .001). Participants who failed the obstacle crossing reported a greater likelihood of falling in the previous year, more balance problems, lower walking ability, and needed longer time to complete 5 chair stands than those who passed the task (all ps < .05). Obstacle-crossing task may identify gait patterns in older adults who appear functionally intact, but who are nonetheless at risk of fall and balance problems.

ITERATOR: A 3D Gait Identification from IR-UWB Technology

A more locally cared for and self-managing aging population along with better attention to self health-care, has resulted in increasing need for non-intrusive monitoring. Wearable, wireless physiological sensors, and cameras can pose user privacy, security and discomfort issues which may have a negative impact on consumer confidence and uptake. Thus, for the first time a non-contact, non-intrusive 3D human motion model is proposed for gait disorder identification from impulse radio ultra-wide band (ITERATOR) with the understanding of spherical trigonometry and vector field. Simultaneously, the Kinect Xbox One is used to compare the outcomes of the proposed IR-UWB model. The experiment comprises twenty-four human participants, where twenty people have normal walking pattern and four persons have spasticity. The height of different body sections from the ground have been recorded for each individual and employed later to distinguish lower and upper human body from the outcomes. The proposed work has transformed the radars backscattered responses through trigonometry and vector algebra where, only vector algebra has been implemented to transform the skeletal data obtained from Kinect. Angles between two thighs have been determined from the proposed UWB algorithm and validated against angles obtained from the Kinect skeletal data using root mean square error (RMSE), where less than 0.5 RMSE has been found.

Co-Ex: A Torque-Controllable Lower Body Exoskeleton for Dependable Human-Robot Co-existence

In this paper, we present our research study concerning the design and development of an exoskeleton that aims to provide 3D walking support with minimum number of actuators. Following a prior simulation study, the joint configuration was primarily determined. In order for the exoskeleton to possess advanced characteristics, the following design criteria were investigated: i) all the actuators (hip/knee/ankle) were deployed around the waist area to decrease leg weight and improve wearability, ii) custom-built series elastic actuators were used to power system for high fidelity torque-controllability, iii) 3D walking support is potentially enabled with reduced power requirements. As a result, we built the first actual prototype to experimentally verify the aforementioned design specifications. Furthermore, the preliminary torque control experiments indicated the viability of torque control.

Variation in pelvic shape and size in Eastern European males: a computed tomography comparative study

Background

The significantly accelerated development of human society in the last millennium has brought about changes in human behavior and body mass that may have influenced human bone morphology. Our objective was to analyze the variation in pelvic shape and size in males from modern and medieval populations.

Methods

We obtained 22 pelvic girdles of adult males from a medieval cemetery located in Cedynia, Poland. The control group comprised 31 contemporary male pelves from individuals inhabiting the same region. The analyzed parameters were: interspinous distance (ISD), intercristal distance (ICD), intertuberous distance (ITD), anatomic conjugate of the pelvis, height of the pelvis (HP), iliac opening angle (IOA), iliac tilt angle (ITA), and ISD/ITD/HP ratio. Geometric morphometrics was used to analyze differences in shape in the pelves. All analyses were carried out on three-dimensional CT reconstructions of pelves.

Results

ISD, ICD, and IOA were significantly greater in modern pelves than in those from Cedynia, but no significant differences were seen between the two groups in ITD, anatomical conjugate, HP, or ITA. ISD/ITD/HP ratios were significantly lower in the Cedynia group. Geometric morphometrics revealed significant differences in pelvic shape between the analyzed groups.

Discussion

The pelves of modern males are larger, wider, and flatter than those of medieval males. Changes in the set of daily activities that produce mechanical loading and estimated body mass may constitute the main factors explaining pelvic variability. However, differences in ontogenesis should also be taken into consideration, especially since growth in past populations is often found to be reduced relative to modern populations.

Critical review of the use and scientific basis of forensic gait analysis

This review summarizes the scientific basis of forensic gait analysis and evaluates its use in the Netherlands, United Kingdom and Denmark, following recent critique on the admission of gait evidence in Canada. A useful forensic feature is (1) measurable, (2) consistent within and (3) different between individuals. Reviewing the academic literature, this article found that (1) forensic gait features can be quantified or observed from surveillance video, but research into accuracy, validity and reliability of these methods is needed; (2) gait is variable within individuals under differing and constant circumstances, with speed having major influence; (3) the discriminative strength of gait features needs more research, although clearly variation exists between individuals. Nevertheless, forensic gait analysis has contributed to several criminal trials in Europe in the past 15 years. The admission of gait evidence differs between courts. The methods are mainly observer-based: multiple gait analysts (independently) assess gait features on video footage of a perpetrator and suspect. Using gait feature databases, likelihood ratios of the hypotheses that the observed individuals have the same or another identity can be calculated. Automated gait recognition algorithms calculate a difference measure between video clips, which is compared with a threshold value derived from a video gait recognition database to indicate likelihood. However, only partly automated algorithms have been used in practice. We argue that the scientific basis of forensic gait analysis is limited. However, gait feature databases enable its use in court for supportive evidence with relatively low evidential value. The recommendations made in this review are (1) to expand knowledge on inter- and intra-subject gait variabilities, discriminative strength and interdependency of gait features, method accuracies, gait feature databases and likelihood ratio estimations; (2) to compare automated and observer-based gait recognition methods; to design (3) an international standard method with known validity, reliability and proficiency tests for analysts; (4) an international standard gait feature data collection method resulting in database(s); (5) (inter)national guidelines for the admission of gait evidence in court; and (6) to decrease the risk for cognitive and contextual bias in forensic gait analysis. This is expected to improve admission of gait evidence in court and judgment of its evidential value. Several ongoing research projects focus on parts of these recommendations.

Interactions Between Transfemoral Amputees and a Powered Knee Prosthesis During Load Carriage

Machines and humans become mechanically coupled when lower limb amputees walk with powered prostheses, but these two control systems differ in adaptability. We know little about how they interact when faced with real-world physical demands (e.g. carrying loads). Here, we investigated how each system (i.e. amputee and powered prosthesis) responds to changes in the prosthesis mechanics and gravitational load. Five transfemoral amputees walked with and without load (i.e. weighted backpack) and a powered knee prosthesis with two pre-programmed controller settings (i.e. for load and no load). We recorded subjects' kinematics, kinetics, and perceived exertion. Compared to the no load setting, the load setting reduced subjects' perceived exertion and intact-limb stance time when they carried load. When subjects did not carry load, their perceived exertion and gait performance did not significantly change with controller settings. Our results suggest transfemoral amputees could benefit from load-adaptive powered knee controllers, and controller adjustments affect amputees more when they walk with (versus without) load. Further understanding of the interaction between powered prostheses, amputee users, and various environments may allow researchers to expand the utility of prostheses beyond simple environments (e.g. firm level ground without load) that represent only a subset of real-world environments.