Abstract
BackgroundTo analyse and interpret gait patterns in pathological paediatric populations, accurate determination of the timing of specific gait events (e.g. initial contract – IC, or toe-off – TO) is essential. As currently used clinical identification methods are generally subjective, time-consuming, or limited to steps with force platform data, several techniques have been proposed based on processing of marker kinematics. However, until now, validation and standardization of these methods for use in diverse gait patterns remains lacking. Research questions1) What is the accuracy of available kinematics-based identification algorithms in determining the timing of IC and TO for diverse gait signatures? 2) Does automatic identification affect interpretation of spatio-temporal parameters?. Methods3D kinematic and kinetic data of 90 children were retrospectively analysed from a clinical gait database. Participants were classified into 3 gait categories: group A (toe-walkers), B (flat IC) and C (heel IC). Five kinematic algorithms (one modified) were implemented for two different foot marker configurations for both IC and TO and compared with clinical (visual and force-plate) identification using Bland-Altman analysis. The best-performing algorithm-marker configuration was used to compute spatio-temporal parameters (STP) of all gait trials. To establish whether the error associated with this configuration would affect clinical interpretation, the bias and limits of agreement were determined and compared against inter-trial variability established using visual identification. ResultsSagittal velocity of the heel (Group C) or toe marker configurations (Group A and B) was the most reliable indicator of IC, while the sagittal velocity of the hallux marker configuration performed best for TO. Biases for walking speed, stride time and stride length were within the respective inter-trial variability values. SignificanceAutomatic identification of gait events was dependent on algorithm-marker configuration, and best results were obtained when optimized towards specific gait patterns. Our data suggest that correct selection of automatic gait event detection approach will ensure that misinterpretation of STPs is avoided.
Highlights
Gait analysis allows detailed characterisation of specific movement and functional deficits and can provide critical support for screening, diagnosing, and monitoring disease progression
Automatic identification of gait events was dependent on algorithm-marker configuration, and best results were obtained when optimized towards specific gait patterns
For group A, varying the force threshold from 10 N/15 N/2%ground reaction forces (GRFs) to 20 N for estimating the timing of gait events using vertical GRFs led to a bias in event-detection errors of up to 4.8 ms with LoAs of 50 ms for estimating the timing of IC (Supplementary material S2)
Summary
Gait analysis allows detailed characterisation of specific movement and functional deficits and can provide critical support for screening, diagnosing, and monitoring disease progression. It has become an established approach in paediatric medicine for assessing motordevelopmental disorders. To analyse and interpret gait patterns in pathological paediatric populations, accurate determination of the timing of specific gait events (e.g. initial contract – IC, or toe-off – TO) is essential. To establish whether the error associated with this configuration would affect clinical interpretation, the bias and limits of agreement were determined and compared against inter-trial variability established using visual identification. Significance: Automatic identification of gait events was dependent on algorithm-marker configuration, and best results were obtained when optimized towards specific gait patterns. Our data suggest that correct selection of automatic gait event detection approach will ensure that misinterpretation of STPs is avoided
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