Human Gait Analysis in Neurodegenerative Diseases: A Review Cicirelli, Grazia; Impedovo, Donato; Dentamaro, Vincenzo ...
IEEE journal of biomedical and health informatics,
2022-Jan., 2022-01-00, 2022-1-00, 20220101, Letnik:
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This paper reviews the recent literature on technologies and methodologies for quantitative human gait analysis in the context of neurodegenerative diseases. The use of technological instruments can ...be of great support in both clinical diagnosis and severity assessment of these pathologies. In this paper, sensors, features and processing methodologies have been reviewed in order to provide a highly consistent work that explores the issues related to gait analysis. First, the phases of the human gait cycle are briefly explained, along with some non-normal gait patterns ( gait abnormalities ) typical of some neurodegenerative diseases. Then the paper reports the most common processing techniques for both feature selection and extraction and for classification and clustering. Finally, a conclusive discussion on current open problems and future directions is outlined.
The increasing popularity of inertial sensors in clinical practice is not supported by precise information on their reliability or guidelines for their use in rehabilitation. The authors investigated ...the state of the literature concerning the use of inertial sensors for gait analysis in both healthy and pathological adults comparing traditional systems. Furthermore, trying to define directions for clinicians.
In accordance with the PRISMA statement, authors searched in PubMed, Web of Science and Scopus all paper published from January 1st, 2005 until December 31st, 2017. They included both healthy and pathological adults' subjects as population, wearable or inertial sensors used for gait analysis and compared with classical gait analysis performed in a Motion Lab as intervention and comparison, gait parameters as outcomes. Considering the methodological quality, authors focused on: sample; description of the study; type of gait analysis used for comparison; type of sensor; sensor placement on the body; gait task requested.
From a total of 888 articles, 16 manuscripts were selected and 7 of them were considered for meta-analysis for different gait parameters. Demographic data, tested devices, reference systems, test procedures and outcomes were analyzed.
Our results show a good agreement between inertial sensors and classical gait analysis for some gait parameters, supporting their use as a solution for capturing kinematic information over an extended space and time and even outside a laboratory in real-life conditions. Authors can support the use of portable inertial sensors for a practical gait analysis in clinical setting with good reliability. It will then be the experience of the clinician to direct the decision-making process.
•Literature on the clinical efficacy of gait analysis (3DGA) has greatly expanded.•There is strong evidence that 3DGA changes and reinforces treatment decisions.•3DGA increases confidence in ...treatment planning and agreement among clinicians.•3DGA can help define diagnostic groups and understand expected treatment outcomes.•3DGA can improve patient outcomes if recommendations are followed.
This paper updates our 2011 systematic review on the clinical efficacy of three-dimensional instrumented gait analysis (3DGA).
What is the current evidence base pertaining to the clinical efficacy of 3DGA?
We identified English language articles published from September 2009 to October 2019 reporting primary research that used typical motion analysis laboratory methods to study human walking. Five gait laboratory experts classified articles according to the highest type of efficacy they addressed: type 1 (technical), 2 (diagnostic accuracy), 2b (outcome prediction), 3−4 (diagnostic thinking and treatment), 5 (patient outcome), 6 (societal). Articles classified into type 3−4 and higher were rated for quality using LEGEND.
Of 2712 articles related to the efficacy of 3DGA, over 99% addressed technical (n = 313), diagnostic (n = 1466), or outcome prediction (n = 927) efficacy. Six type 3−4 studies showed that 3DGA changes treatment plans, increases clinicians’ confidence in their treatment decisions, and increases agreement among clinicians. Two type 5 articles based on a randomized controlled trial demonstrated that patient outcomes improved only when 3DGA data were available and its recommendations were followed. A population-based type 5 study found that the incidence of severe crouch gait dropped from 25% to 4% following practice changes including the addition of 3DGA. The strength of evidence was mainly 3b (lesser quality prospective cohort studies) but also included stronger studies (three level 2 controlled clinical trials).
Literature related to the clinical efficacy of 3DGA has grown substantially over the last decade. Thousands of articles contribute to continued improvement of data collection and interpretation, as well as understanding of gait pathology and treatment. A smaller number of studies clearly demonstrate the efficacy of 3DGA in changing and reinforcing treatment decisions, increasing clinicians’ confidence in treatment planning, and increasing agreement among clinicians, as well as the potential to improve patient outcomes.
Gait analysis is a significant diagnostic procedure for the clinicians who manage musculoskeletal disorders. Surface electromyography (sEMG) combined with kinematic and kinetic data is a useful tool ...for decision making of the appropriate method needed to treat such patients. sEMG has been used for decades to evaluate neuromuscular responses during a range of activities and develop rehabilitation protocols. The sEMG methodology followed by researchers assessed the issues of noise control, wave frequency, cross talk, low signal reception, muscle co-contraction, electrode placement protocol and procedure as well as EMG signal timing, intensity and normalisation so as to collect accurate, adequate and meaningful data. Further research should be done to provide more information related to the muscle activity recorded by sEMG and the force produced by the corresponding muscle during gait analysis.
Acoustic stimulation appears to be a promising strategy in reducing the risk of falling in older adults, demonstrating effectiveness in improving stability. However, its impact on movement ...variability, another crucial indicator of fall risk, seems to be limited. This study aims to assess movement variability during walking in a cohort of healthy older adults exposed to three different frequencies of acoustic stimulation (90%, 100% and 110% of each subject’s average cadence). Using a systemic approach based on network theory, which considers the intricate relationships between all body segments, we constructed connectivity matrices composed of nodes, represented by bony landmarks, and edges, consisting of the standardised covariance of accelerations between each pair of nodes. By introducing a new metric called Similarity Score (S-score), we quantified the ability of each individual to repeat the same motor pattern at each gait cycle under different experimental conditions. The study revealed that rhythmic auditory stimulation (RAS) at 100% and 90% of the mean cadence significantly increased the S-scores compared to the baseline. These results highlight the effects of RAS in increasing gait repeatability in healthy older adults, with a focus on global kinematics.
•An open framework for working with the Conventional Gait Model.•Replication of all Vicon Plugin Gait Variants.•Correction and Improvement of the Plugin Gait.•Proposal of a CGM1.1: A plugin-gait as ...it should work today.
The Conventional Gait Model (CGM), known by a variety of different names, is widely used in clinical gait analysis. We present pyCGM2, an open-source implementation of the CGM with two versions. The first, CGM1.0, is a clone of Vicon Plug In Gait (PiG) with all its variants. CGM1.0 provides a platform to test the effect of modifications to the CGM on data collected and processed retrospectively or to provide backward compatibility.
The second version, CGM1.1, offers some practical modifications and includes three well documented improvements.
How do improvements of the conventional gait model affect joint kinematics and kinetics?
The practical modifications include the possibility to use a medial knee epicondyle marker, during static calibration only, to define the medio-lateral axis of the femur in place of the knee alignment device. The three improvements correspond to the change of pelvis angle decomposition sequence, the adoption of a single tibia coordinate system, and the default decomposition of the joint moments in the joint coordinate system. We validated the outputs of version CGM1.0 against Vicon-PiG, and estimated the effect of the modifications included in version CGM1.1 using gait data collected in 16 healthy participants.
Kinematics and kinetics of CGM1.0 were superimposed with that of Vicon-PiG, with root mean square differences less than 0.04° for kinematics and less than 0.05 N.m.kg-1 for kinetics.
The differences between the CGM1.1 and CGM1.0 were minimal in the healthy participant cohort but we discussed the expected difference in participants with different gait pathologies.
We hope that the pyCGM2 will facilitate the systematic testing and the use of improved processing methods for the conventional gait model.
Ankle Foot Orthoses (AFOs) are frequently prescribed to manage gait impairments in children with physical disability, and it is important that AFOs are prescribed and fitted appropriately to maximize ...potential benefits. AFO tuning, manipulation of the AFO footwear combination (AFO-FC) by means of video vector analysis, is routinely used to optimize AFO use. However, the incidence or types of changes that are implemented after this type of orthotic review are unknown.
To investigate the impact of a multi-disciplinary video vector clinic on AFO provision in children with physical disability.
All children who attended a video vector clinic over a period of 10-years from the establishment of the clinic were included in the study. Outcomes of the clinic were grouped into 5 categories: (1) No change to AFO-FC; (2) Altered/tuned AFO-FC; (3) Discontinued AFO-FC; (4) Recast AFO; (5) Change in prescription. Data were summarised narratively.
141 independently ambulant children were included. The diagnoses were bilateral cerebral palsy (39 %, n=55), unilateral cerebral palsy (38 %, n=54), spina bifida (9 %, n=13), hereditary spastic paraparesis (2 %, n=3) and other (11 %, n=16). No changes were made in 52 % of cases (n=74), tuning in 22 % of cases (n=31), the AFO was recast in 13 % of cases (n=19) and discontinued in 10 % of cases (n=14). A prescription change was recommended in 3 % of cases (n=4).
Our findings suggest that the video vector clinic is a time efficient and effective means of assessing gait function in children with AFOs. Without assessment at the clinic, most of the children assessed would likely have been referred for a full and more time consuming 3-dimensional gait analysis. Video vector analysis at the initial AFO fitting may improve alignment and possibly reduce non-compliance at an earlier stage.
•Video Vector analysis resulted in changes in 48 % of orthoses.•Children with CP accounted for 77 % of all those assessed at the clinic.•Video vector clinic is a time efficient assessment of gait in children with AFOs.
Comprehensive computerized gait analysis (CGA) alters orthopedic surgical plans and improves outcomes. Despite these documented benefits, CGA is not widely available to all patients who could be ...helped by it.
Research Question: Do social determinants of health impact access to CGA?
Retrospective review of patients seen for CGA from 2021 to 2022. Dates of referral, insurance approval and completion of CGA, demographics and insurance type were extracted from patient records. Zip codes were used to determine the neighborhood socioeconomic status (SES). Data were analyzed using non-parametric statistics.
Insurance type affected time to authorization (private insurance/self-pay: median 9 days; HMO insurance: median 51.5 days; public insurance: median 27 days; p=0.0004). Once authorized, insurance type did not affect time to schedule and complete CGA (p=0.76). Lower neighborhood SES was associated with longer time to authorization but shorter time to complete CGA once authorized. Rescheduling was associated with longer time to complete CGA once authorized (median 29.5 vs. 16 days, p<0.0001). White, non-Hispanic families tended to reschedule more often than non-white or Hispanic families (35 % vs. 18 %, p=0.07).
Knowledge of barriers to CGA is necessary in order to design and implement effective strategies to widen its availability to all whom it could benefit. Social determinants of health and insurance type are associated with delays in authorization for CGA. Families with public insurance and HMO coverage experience delays in obtaining insurance authorization compared to PPO/self-pay patients, whose tests did not require prior authorization. However, there can also be delays in scheduling and completing CGA once authorized. This is a multi-faceted issue that requires further research.
•Low neighborhood SES and public or HMO insurance delayed authorization for CGA.•Low neighborhood SES and public or HMO insurance did not delay CGA once authorized.•White, non-Hispanic patients had high neighborhood SES and rescheduled more often.•Primary language and race/ethnicity did not impact access to CGA.
Gait analysis is necessary to diagnose movement disorders. In order to reduce the costs of three-dimensional motion capture systems, new low-cost methods of motion analysis have been developed. The ...purpose of this study was to evaluate the inter- and intra-rater reliability of Kinovea
and the agreement with a three-dimensional motion system for detecting the joint angles of the hip, knee and ankle during the initial contact phase of walking. Fifty healthy subjects participated in this study. All participants were examined twice with a one-week interval between the two appointments. The motion data were recorded using the VICON Motion System
and digital video cameras. The intra-rater reliability showed a good correlation for the hip, the knee and the ankle joints (Intraclass Correlation Coefficient, ICC > 0.85) for both observers. The ICC for the inter-rater reliability was >0.90 for the hip, the knee and the ankle joints. The Bland-Altman plots showed that the magnitude of disagreement was approximately ±5° for intra-rater reliability, ±2.5° for inter-rater reliability and around ±2.5° to ±5° for Kinovea
versus Vicon
. The ICC was good for the hip, knee and ankle angles registered with Kinovea
during the initial contact of walking for both observers (intra-rater reliability) and higher for the agreement between observers (inter-rater reliability). However, the Bland-Altman plots showed disagreement between observers, measurements and systems (Kinovea
vs. three-dimensional motion system) that should be considered in the interpretation of clinical evaluations.
Forensic gait analysis is used to visually and quantitatively analyze information regarding the appearance and style of walking that can be presented as evidence in the court. The demand for ...analyzing CCTV pedestrian footage in video surveillance has been increasing. The dependence of the accuracy of semiautomatic silhouette‐based analysis, often used in forensic science, on the differences in the viewing directions is a very challenging issue that is yet to be resolved for real case applications. Currently, the different viewing directions used in comparison footage significantly decrease the accuracy of same person analysis when using the silhouette‐based method, often used in the Japanese forensic science domain. A calibration‐based method was previously prosed to resolve this problem, but it requires performing an elaborate measurement procedure at the camera installation site for an accurate analysis. In this study, we propose a novel in‐silico silhouette‐based analysis method that significantly expands the number of viewing direction pre‐set settings to 900 from the 24 used in the previous method. Several software tools have been developed to ensure that all the procedures can be executed on a computer. The experimental results confirm that the accuracy of the proposed method is comparable to that of the calibration‐based method. Furthermore, the practical comparison results from actual consultation confirmed the effectiveness of the proposed method under existing viewing direction differences. We therefore anticipate that the proposed method will be beneficial for improving the analysis accuracy in real cases and therefore serve as a substitute of the previous method.
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