Validity of AI-Based Gait Analysis for Simultaneous Measurement of Bilateral Lower Limb Kinematics Using a Single Video Camera.

Accuracy validation of gait analysis using pose estimation with artificial intelligence (AI) remains inadequate, particularly in objective assessments of absolute error and similarity of waveform patterns. This study aimed to clarify objective measures for absolute error and waveform pattern similarity in gait analysis using pose estimation AI (OpenPose). Additionally, we investigated the feasibility of simultaneous measuring both lower limbs using a single camera from one side. We compared motion analysis data from pose estimation AI using video footage that was synchronized with a three-dimensional motion analysis device. The comparisons involved mean absolute error (MAE) and the coefficient of multiple correlation (CMC) to compare the waveform pattern similarity. The MAE ranged from 2.3 to 3.1° on the camera side and from 3.1 to 4.1° on the opposite side, with slightly higher accuracy on the camera side. Moreover, the CMC ranged from 0.936 to 0.994 on the camera side and from 0.890 to 0.988 on the opposite side, indicating a "very good to excellent" waveform similarity. Gait analysis using a single camera revealed that the precision on both sides was sufficiently robust for clinical evaluation, while measurement accuracy was slightly superior on the camera side.

Pelvic Rotation Is Associated With Asymmetry in the Knee Extensor Moment During Double-Leg Squatting After Anterior Cruciate Ligament Reconstruction.

Asymmetry in knee extensor moment during double-leg squatting was observed after anterior cruciate ligament reconstruction, even after the completion of the rehabilitation program for return to sports. The purpose of this study was to clarify the association between asymmetry in the knee extensor moment and pelvic rotation angle during double-leg squatting after anterior cruciate ligament reconstruction. Twenty-four participants performed double-leg squatting. Kinetics and kinematics during squatting were analyzed using a 3-dimensional motion analysis system with 2 force plates. The limb symmetry index of knee extensor moment was predicted by the pelvic rotation angle (R2 = .376, P = .001). In addition, the pelvic rotation and the limb symmetry index of the vertical ground reaction force independently explained the limb symmetry index of the knee extensor moment (R2 = .635, P < .001, ß of pelvic rotation = -0.489, ß of vertical ground reaction force = 0.524). Pelvic rotation toward the involved limb was associated with a smaller knee extensor moment in the involved limb than in the uninvolved limb. The assessment of pelvic rotation would be useful for partially predicting asymmetry in the knee extensor moment during double-leg squatting. Minimizing pelvic rotation may improve the asymmetry in the knee extensor moment during double-leg squatting after anterior cruciate ligament reconstruction.

Subsequent Jumping Increases the Knee and Hip Abduction Moment, Trunk Lateral Tilt, and Trunk Rotation Motion During Single-Leg Landing in Female Individuals.

Single-leg landings with or without subsequent jumping are frequently used to evaluate landing biomechanics. The purpose of this study was to investigate the effects of subsequent jumping on the external knee abduction moment and trunk and hip biomechanics during single-leg landing. Thirty young adult female participants performed a single-leg drop vertical jumping (SDVJ; landing with subsequent jumping) and single-leg drop landing (SDL; landing without subsequent jumping). Trunk, hip, and knee biomechanics were evaluated using a 3-dimensional motion analysis system. The peak knee abduction moment was significantly larger during SDVJ than during SDL (SDVJ 0.08 [0.10] N·m·kg-1·m-1, SDL 0.05 [0.10] N·m·kg-1·m-1, P = .002). The trunk lateral tilt and rotation angles toward the support-leg side and external hip abduction moment were significantly larger during SDVJ than during SDL (P < .05). The difference in the peak hip abduction moment between SDVJ and SDL predicted the difference in the peak knee abduction moment (P = .003, R2 = .252). Landing tasks with subsequent jumping would have advantages for evaluating trunk and hip control as well as knee abduction moment. In particular, evaluating hip abduction moment may be important because of its association with the knee abduction moment.

Side-to-side differences of three-dimensional knee kinematics during walking by normal subjects.

[Purpose] The purpose of this study was to determine the normal range of the side-to-side difference in three dimensional knee kinematics measured by the point cluster technique (PCT). [Subjects] The subjects were twenty-one healthy normal volunteers without knee pain or an episode of injury to the legs. [Methods] The subjects were tested bilaterally at a self-selected normal walking speed and six degrees of freedom knee kinematics were measured using the PCT, and the 95% confidence intervals of the average side-to-side differences in flexion-extension (FE), adduction-abduction (AA), internal-external (IE) rotation, and anterior-posterior (AP), medial-lateral (ML), superior-inferior (SI) translation in each stage of the gait cycle were determined. [Results] The average side-to-side differences and their 95% confidence intervals in rotation/translation in each stage of the gait cycle were determined. The side-to-side differences in AA rotation and AP translation of the tibia were significantly larger in the swing phase than in the stance phase. [Conclusion] The side-to-side differences in AA rotation and AP translation were highly dependent on the stage of the gait cycle. Therefore, the normal ranges of the side-to-side differences in knee kinematics in each stage of the gait cycle, in particular AA rotation and AP translation of the tibia, is useful information for evaluating knee kinematics during walking.

Effect of heel pressure pad attached to ankle-foot orthosis on the energy conversion efficiency in post-stroke hemiplegic gait.

[Purpose] This study aimed to analyze the effect of heel pads in ankle-foot orthoses on dynamic motion aspects of gait in stroke patients from the viewpoint of energy conversion efficiency. [Subjects] Fourteen chronic stroke patients who were ambulatory and had lower extremity motor function categorized as Brunnstrom stage IV participated in the study. [Methods] A three-dimensional motion analysis system was used to assess the effect of heel pad intervention on dynamic motion gait parameters using a single-system A-B-A design. [Results] The results showed that a heel pad attached to the ankle-foot orthosis caused significant retention of the center-of-pressure at the heel during the heel rocker function and significant increase in the dorsiflexion moment and the height of the center of gravity. [Conclusion] The present study showed that a heel pad attached to the calcaneal region of an ankle-foot orthosis caused slight retention of the center-of-pressure at the heel during the heel rocker function along with center of gravity elevation in the stance phase and improved the energy conversion efficiency, especially on the non-paretic side.

Development of an algorithm to predict comfort of wheelchair fit based on clinical measures.

[Purpose] The purpose of this study was to develop an algorithm to predict the comfort of a subject seated in a wheelchair, based on common clinical measurements and without depending on verbal communication. [Subjects] Twenty healthy males (mean age: 21.5 ± 2 years; height: 171 ± 4.3 cm; weight: 56 ± 12.3 kg) participated in this study. [Methods] Each experimental session lasted for 60 min. The clinical measurements were obtained under 4 conditions (good posture, with and without a cushion; bad posture, with and without a cushion). Multiple regression analysis was performed to determine the relationship between a visual analogue scale and exercise physiology parameters (respiratory and metabolism), autonomic nervous parameters (heart rate, blood pressure, and salivary amylase level), and 3D-coordinate posture parameters (good or bad posture). [Results] For the equation (algorithm) to predict the visual analogue scale score, the adjusted multiple correlation coefficient was 0.72, the residual standard deviation was 1.2, and the prediction error was 12%. [Conclusion] The algorithm developed in this study could predict the comfort of healthy male seated in a wheelchair with 72% accuracy.

Estimation of Vertical Ground Reaction Force during Single-leg Landing Using Two-dimensional Video Images and Pose Estimation Artificial Intelligence.

OBJECTIVE: Assessment of the vertical ground reaction force (VGRF) during landing tasks is crucial for physical therapy in sports. The purpose of this study was to determine whether the VGRF during a single-leg landing can be estimated from a two-dimensional (2D) video image and pose estimation artificial intelligence (AI). METHODS: Eighteen healthy male participants (age: 23.0 ± 1.6 years) performed a single-leg landing task from a 30-cm height. The VGRF was measured using a force plate and estimated using center of mass (COM) position data from a 2D video image with pose estimation AI (2D-AI) and three-dimensional optical motion capture (3D-Mocap). The measured and estimated peak VGRFs were compared using a paired t-test and Pearson's correlation coefficient. The absolute errors of the peak VGRF were also compared between the two estimations. RESULTS: No significant difference in the peak VGRF was found between the force plate measured VGRF and the 2D-AI or 3D-Mocap estimated VGRF (force plate: 3.37 ± 0.42 body weight [BW], 2D-AI: 3.32 ± 0.42 BW, 3D-Mocap: 3.50 ± 0.42 BW). There was no significant difference in the absolute error of the peak VGRF between the 2D-AI and 3D-Mocap estimations (2D-AI: 0.20 ± 0.16 BW, 3D-Mocap: 0.13 ± 0.09 BW, P = 0.163). The measured peak VGRF was significantly correlated with the estimated peak by 2D-AI (R = 0.835, P <0.001). CONCLUSION: The results of this study indicate that peak VGRF estimation using 2D video images and pose estimation AI is useful for the clinical assessment of single-leg landing.

Kinematic characteristics of canine hindlimb movement during sit-to-stand and stand-to-sit motions.

Sit-to-stand and stand-to-sit motions are basic motions for daily animal life, and these motions are used as therapeutic exercises for dogs with functional impairments. The sit-to-stand motion is divided into several phases for kinesiological assessment in human rehabilitation and physical therapy. However, these motions in dogs have not been characterized in detail. We examined canine hindlimb kinematic characteristics during sit-to-stand/stand-to-sit motions and compared the characteristics with those during walking. In addition, we tried to classify phases of the movements based on kinematic characteristics of the transition of the range of motion of the hindlimb. We used a three-dimensional motion analysis system to evaluate the motions of eight clinically healthy beagles. During the sit-to-stand motion, the total range of motion (ROM) in the hip joint flexion/extension was half of that of during walking, but the total ROM of the hindlimb external/internal rotation relative to the pelvis and flexion/extension of the stifle and the tarsal joints were significantly larger than those of walking, suggesting that sit-to-stand exercise causes movements of hindlimb joints without marked changes in hip joint flexion/extension movement. Both sit-to-stand and stand-to-sit motions could not be divided into multiple phases only by the transition of the range of motion of the hindlimb.

Interlimb Asymmetry in Knee Extension Moment During Double-Leg Squatting Is Associated With Persistent Quadriceps Weakness After ACL Reconstruction.

Background: Although double-leg squatting is less dynamic and places less demand on the quadriceps compared with landing tasks, the relationship between double-leg squatting biomechanics and persistent quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is unknown. Purpose: To clarify the relationships between asymmetries in quadriceps strength and lower limb biomechanics during double-leg squatting >1 year after ACLR. Study Design: Controlled laboratory study. Methods: A total of 26 participants (5.5 ± 3.8 years after ACLR) were enrolled. The limb symmetry index (LSI) of isokinetic quadriceps strength was used to divide participants into the high-quadriceps (HQ) group (LSI ≥90%; n = 18) and the low-quadriceps (LQ) group (LSI <90%; n = 8). The knee, hip, and ankle extension moment (relative to body weight and support moment [sum of knee, hip, and ankle moments]) and vertical ground-reaction force during double-leg squatting were analyzed using 3-dimensional motion analysis. The association of quadriceps strength and biomechanical variables was tested using 2-way analysis of variance and univariate regression analysis. Results: A significant group-by-limb interaction was found for the peak knee extension moment and the ratios of knee and hip extension moment to support moment (P < .001, P = .015 and P < .001, respectively). The LQ group showed a significantly smaller peak knee extension moment and knee to support moment ratio but a larger hip to support moment ratio in the involved limb than in the uninvolved limb (95% CIs: knee extension moment, -0.273 to -0.088 N·m/kg; knee to support moment ratio, -10.7% to -2.2%; hip to support moment ratio, 3.2% to 8.5%). No interlimb difference was found for the HQ group. The LSI of quadriceps strength was significantly associated with the LSI of peak knee extension moment (R2 = 0.183), knee to support moment ratio (R2 = 0.256), and hip to support moment ratio (R2 = 0.233). The mean maximum isokinetic quadriceps strength and peak knee extension moment during squatting on the involved limb of the LQ group were 2.40 ± 0.39 and 0.90 ± 0.16 N·m/kg, respectively. Conclusion: Asymmetrical biomechanics during double-leg squatting was associated with persistent quadriceps weakness after ACLR. The LQ group had reduced knee extensor moment on the involved side during squatting despite loading at approximately half the maximum strength. Clinical Relevance: Quadriceps strengthening exercises, together with interventions to improve neuromuscular control, may reduce asymmetrical biomechanics during double-leg squatting.

The effects of relative trunk rotation velocity on ball speed and elbow and shoulder joint torques during baseball pitching.

In baseball pitching, suppressing trunk rotation while rotating the pelvis in the early phase of arm cocking is important for throwing a fast ball. However, quantitative evaluation of trunk rotation during pitching has not been established, and its associations with elbow and shoulder torques are unclear. The purpose of this study was to examine the correlation of a new measure of trunk rotation suppression with ball speed and elbow and shoulder torques during pitching. Eighteen adult male baseball pitchers (21.7 ± 1.2 years old) participated. Three qualified pitches were analysed using a three-dimensional motion capture system. Trunk rotation velocity, normalised to the peak velocity, was derived at the time of peak pelvic velocity. Pearson's correlation coefficient was used to determine correlations. The normalised trunk rotation velocity at the peak pelvic velocity was significantly correlated with elbow valgus torque (R = -0.508, P = 0.032), shoulder external rotation torque (R = -0.507, P = 0.032) and ball speed (R = -0.504, P = 0.033). A smaller normalised trunk rotation angular velocity at the time of peak pelvic rotation velocity could increase ball speed but may also increase elbow and shoulder torques among pitchers who demonstrate trunk rotation after foot contact.

Functional assessment of the gluteus medius, cranial part of the biceps femoris, and vastus lateralis in Beagle dogs based on a novel gait phase classification.

In humans, walking analysis based on the gait phase classification has been used for interpretation of functional roles of different movements occurring at individual joints, and it is useful for establishing a rehabilitation plan. However, there have been few reports on canine gait phase classification, and this is one of the reasons for preventing progress in canine rehabilitation. In this study, we determined phases of the canine gait cycle (GC) on the basis of the phase classification for human gait. The canine GC was able to be divided into initial contact (IC) and the following 5 phases: loading response (LR), middle stance (MidSt), pre-swing (PSw), early swing (ESw), and late swing (LSw). Next, the hind limb joint angles of the hip, stifle and tarsal joints and results of surface electromyography of the gluteus medius (GM), cranial part of the biceps femoris (CBF) and vastus lateralis (VL) muscles in relation to the gait phases were analyzed. The activities of three muscles showed similar changes during walking. The muscle activities were high in the LR phase and then declined and reached a minimum in the PSw phase, but they increased and reached a peak in the LSw phase, which was followed by the LR phase. In conclusion, the multiphasic canine GC was developed by modification of the human model, and the GC phase-related changes in the muscle activity and joint angles suggested the functions of GM, CBF and VL muscles in walking.

Larger hip external rotation motion is associated with larger knee abduction and internal rotation motions during a drop vertical jump.

Associations among hip motions, knee abduction and internal rotation motion during a drop vertical jump (DVJ), which increases the risk of anterior cruciate ligament injury, remain unclear. The purpose of this study was to examine associations among knee abduction, internal rotation and hip joint motions during a DVJ. Fifty-seven young female participants performed a DVJ from a 30-cm height. Hip and knee kinematics and kinetics were analysed using a three-dimensional motion analysis system and force plates. Multiple regression analysis showed that peak knee abduction angle was negatively associated with knee internal rotation and hip internal rotation excursions from initial contact (IC) to peak knee flexion, and positively associated with peak knee abduction moment (R2 = 0.465, P< 0.001). Peak knee internal rotation angle was negatively associated with the hip flexion excursion from IC to peak knee flexion and peak hip adduction moment (R2 = 0.194, P= 0.001). In addition, hip internal rotation excursion was negatively associated with knee abduction and internal rotation excursion from IC to 50 ms after IC. To avoid a large knee abduction and internal rotation motion during jump-landing training, it might be beneficial to provide landing instructions to avoid a large hip external rotation motion.

Kinematics and center of axial rotation during walking after medial pivot type total knee arthroplasty.

PURPOSE: In recent years, the medial pivot (MP) type total knee arthroplasty (TKA) implant has been developed and marketed for achieving more natural kinematics with MP. However, little is known about the pivot pattern during walking after MP type TKA. This study aimed to determine the kinematics and center of axial rotation during walking after MP type TKA. METHODS: This randomized prospective study enrolled 40 patients with MP type TKA, 20 with cruciate-substituting TKA (MP-CS group), 20 with posterior-stabilized TKA (MP-PS group), and 10 healthy volunteers (control group). The kinematics and center of axial rotation during overground walking were measured by a three-dimensional motion analysis system. The six-degrees-of-freedom kinematics of the knee were calculated by the point cluster method. RESULTS: The amount of change in knee flexion in early stance phase was significantly lower in the MP-CS and MP-PS groups than in the control group. The femur showed anterior translation during early stance phase in all three groups. The median center of axial rotation in the transverse plane was predominantly on the lateral side of the knee during stance in all groups. CONCLUSIONS: Kinematics during gait are thought to be determined by physical posture, the kinetic chain during weight-bearing, and the kinematic features of adjacent structures, such as the behavior of the biarticular muscles. MP-CS and MP-PS did not necessarily induce rotational motion centered on the medial ball-in-socket component during walking; translational and lateral pivoting movements were also observed. Long-term follow-up is needed to monitor for polyethylene wear and implant loosening.

Landing instructions focused on pelvic and trunk lateral tilt decrease the knee abduction moment during a single-leg drop vertical jump.

OBJECTIVES: To investigate the effects of pelvic and trunk lateral tilt-focused landing instructions on the knee abduction moment during the single-leg drop vertical jump task. DESIGN: Descriptive laboratory study. SETTING: Motion analysis laboratory. PARTICIPANTS: Fifteen young, healthy female participants. MAIN OUTCOME MEASURES: The participants performed 15 single-leg drop vertical jumps. Landing instructions with self-video recordings were provided so that the participants' pelvis and trunk remained horizontal in the frontal plane. Pelvic, trunk and knee kinematics and kinetics were evaluated using a three-dimensional motion analysis system before and after the landing instructions. RESULTS: The peak knee abduction moment significantly decreased postinstruction (preinstruction 22.6 ± 15.3 Nm, postinstruction 17.9 ± 15.4 Nm, P = 0.004), as did pelvic and trunk lateral tilt (P < 0.01). The knee abduction and internal rotation angles at initial contact significantly decreased postinstruction (P = 0.037, P = 0.007), with no significant change in the peak knee abduction and internal rotation angles from pre-to postinstruction. CONCLUSIONS: Landing instructions focused on pelvic and trunk lateral tilt are effective in decreasing the knee abduction moment during the single-leg drop vertical jump. Pelvic and trunk lateral tilt should be controlled to decrease the knee abduction moment during single-leg landing.

Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures.

The aim of this study was to evaluate the thickness of the transversus abdominis (TrA) muscle in three basic postures in subjects with and without chronic low back pain. Subjects were classified into a chronic low back pain group (n = 27) and a healthy control group (n = 23). The thickness of the TrA muscle was measured at rest and during the abdominal drawing-in manoeuvre (ADIM) in supine, sitting and standing postures using B-mode ultrasound imaging. Contraction ratio (TrA thickness during the ADIM/TrA thickness at rest) was calculated for each posture. At rest, the TrA thickness in the sitting and standing postures was significantly greater than in the supine posture (p < 0.017) in the control group, but similar in all three postures in the low back pain group. TrA thickness was similar in the low back pain and control group in all three postures. During the ADIM, TrA thickness was significantly greater in the control group than in the chronic low back pain group in all three postures. The contraction ratio was also significantly higher in the control group than in the chronic low back pain group in all three postures. These results indicate that the automatic postural contraction of the TrA observed in the control subjects in the sitting and standing postures was not demonstrated in subjects with chronic low back pain. The present study revealed the one aspect of different response of the TrA muscle to changing posture between two groups.