Abstract
For interpreting outcomes of clinical gait analysis, an accurate estimation of gait events, such as initial contact (IC) and toe-off (TO), is essential. Numerous algorithms to automatically identify timing of gait events have been developed based on various marker set configurations as input. However, a systematic overview of the effect of the marker selection on the accuracy of estimating gait event timing is lacking. Therefore, we aim to evaluate (1) if the marker selection influences the accuracy of kinematic algorithms for estimating gait event timings and (2) what the best marker location is to ensure the highest event timing accuracy across various gait patterns. 104 individuals with cerebral palsy (16.0 ± 8.6 years) and 31 typically developing controls (age 20.6 ± 7.8) performed clinical gait analysis, and were divided into two out of eight groups based on the orientation of their foot, in sagittal and frontal plane at mid-stance. 3D marker trajectories of 11 foot/ankle markers were used to estimate the gait event timings (IC, TO) using five commonly used kinematic algorithms. Heatmaps, for IC and TO timing per group were created showing the median detection error, compared to detection using vertical ground reaction forces, for each marker. Our findings indicate that median detection errors can be kept within 7 ms for IC and 13 ms for TO when optimizing the choice of marker and detection algorithm toward foot orientation in midstance. Our results highlight that the use of markers located on the midfoot is robust for detecting gait events across different gait patterns.
Highlights
Gait Event Timing of gait events could lead to errors in normalization of kinematic and kinetic data and its ensemble-averaging, as well as to inaccurate spatio-temporal parameters
For estimating the timing of initial contact (IC) across groups, the best estimations were obtained when using the algorithm proposed by Hreljac et al with SITA marker for typically developing (TD), and the algorithm proposed by Ghoussayni et al with SITA or PMT5 marker for cerebral palsy (CP)
The aim of this manuscript was to provide a systematic overview of the effects that marker selection has on the accuracy of gait event timing estimation
Summary
Gait Event Timing of gait events could lead to errors in normalization of kinematic and kinetic data and its ensemble-averaging, as well as to inaccurate spatio-temporal parameters. The gold standard for estimating gait event timing is the use of vertical ground reaction forces (vGRFs), during which a threshold is set, when the vGRF crossed the force threshold a gait event is detected (Bruening and Ridge, 2014). For this method to work in an automatic manner, clean force plate hits (during which only one foot contacts a force plate) are necessary. A systematic overview of the effect of the markers’ locations on the accuracy of estimating gait event timing is lacking
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