Soft Tissue Artifact Research Articles

The influence of different pelvic technical marker sets upon hip kinematics during gait

BackgroundThe pelvis is commonly tracked during three-dimensional motion analysis using markers located on the anterior and posterior superior iliac spines. However, these markers are prone to soft tissue artefact and marker occlusion, highlighting the need for alternative technical marker sets. Research questionHow comparable are hip joint kinematics calculated using two alternative pelvic technical marker sets and a conventionally modelled pelvis? MethodsFourteen participants undertook 3D gait analysis, walking overground at a self-selected pace (1.38 ± 0.14 m·s−1), barefoot. Hip joint kinematics were compared using root mean square error (RMSE) between a conventionally tracked pelvis and two alternative technical marker sets; (1) posterior cluster and (2) additional iliac crest markers. ResultsThe average RMSE in the sagittal, frontal and transverse planes was 2.5° ± 2.8°, 1.6° ± 0.4° and 0.8° ± 0.4°, respectively for the posterior cluster, and 1.3° ± 0.7°, 0.8° ± 0.3° and 1.4° ± 0.5° for the iliac crest marker set. The RMSE was significantly larger for the posterior cluster compared to the iliac crest model in the sagittal (p = .05, d = .28) and frontal planes (p < .001, d = 7.65). In contrast, the RMSE was significantly lower for the posterior cluster in the transverse plane (p = .01, d = -2.85). SignificanceThe findings of this study suggest that either a posterior cluster or additional iliac crest markers offer means of accurately calculating hip joint kinematics within 3° of the conventional pelvic model. Therefore, either technical marker set offers a viable alternative to the conventional pelvic model for calculating hip joint kinematics.

Measuring clinically relevant knee motion with a self-calibrated wearable sensor

Low-cost sensors provide a unique opportunity to continuously monitor patient progress during rehabilitation; however, these sensors have yet to demonstrate the fidelity and lack the calibration paradigms necessary to be viable tools for clinical research. The purpose of this study was to validate a low-cost wearable sensor that accurately measured peak knee extension during clinical exercises and needed no additional equipment for calibration. Sagittal plane knee motion was quantified using a 9-axis motion sensor and directly compared to motion capture data. The motion sensor measured the field strength of a strong earth magnet secured to the distal femur, which was correlated with knee angle during a simple calibration process. Peak knee motions and kinematic patterns were compared with motion capture data using paired t-tests and cross correlation, respectively. Peak extension values during seated knee extensions were accurate within 5 degrees across all subjects (root mean square error: 2.6 degrees, P = 0.29). Knee flexion during gait strongly correlated (0.84 ≤ rxy ≤ 0.99) with motion capture measurements but demonstrated peak flexion errors of 10 degrees. In this study, we present a low-cost sensor (≈$ 35 US) that accurately determines knee extension angle following a calibration procedure that did not require any other equipment. Our findings demonstrate that this sensor paradigm is a feasible tool to monitor patient progress throughout physical therapy. However, dynamic motions that are associated with soft-tissue artifact may limit the accuracy of this type of wearable sensor.

“Dynamic knee valgus” – Are we measuring what we think we’re measuring? An evaluation of static and functional knee calibration methods for application in gait and clinical screening tests of the overhead squat and hurdle step

Background"Dynamic knee valgus” has been identified as a risk factor for significant knee injuries, however, the limits and sources of error associated with existing 3D motion analysis methods have not been well established. Research questionWhat effect does the use of differing static and functional knee axis orientation methods have on the observed knee angle outputs for the activities of gait, overhead squatting and a hurdle step? MethodsA pre-existing dataset collected from one season (September 2015–May 2016) as part of a prospective observational longitudinal study was used. A secondary analysis of data for 24 male footballers, from a single British University football team, was conducted in order to evaluate the effect of static (conventional gait model) and dynamic (constrained and unconstrained mDynaKAD) methods on knee joint kinematics for flexion-extension and valgus-varus angles. ResultsNo single calibration method consistently achieved both the highest flexion and lowest valgus angle for all tests. The constrained and unconstrained mDynaKAD methods achieved superior alignment of the knee medio-lateral axis compared to the conventional gait model, when the movement activity served as its own calibration. The largest mean difference between methods for sagittal and coronal plane kinematics was less than 4° and 14° respectively. Cross-talk could not account for all variation within the results, highlighting that soft tissue artefact, associated with larger muscle volumes and movements, can influence kinematics results. SignificanceWhen considering the trade-off between achieving maximum flexion and minimal valgus angle, the results indicate that the mDynaKAD methods performed best when the selected movement activity served as its own calibration method for all activities. Clinical decision making processes obtained through use of these methods should be considered in light of the model errors associated with cross-talk and effect of soft tissue artefact.

Validation of inertial measurement units with optical tracking system in patients operated with Total hip arthroplasty

BackgroundPatient reported outcome measurement (PROMs) will not capture in detail the functional joint motion before and after total hip arthroplasty (THA). Therefore, methods more specifically aimed to analyse joint movements may be of interest. An analysis method that addresses these issues should be readily accessible and easy to use especially if applied to large groups of patients, who you want to study both before and after a surgical intervention such as THA. Our aim was to evaluate the accuracy of inertial measurement units (IMU) by comparison with an optical tracking system (OTS) to record pelvic tilt, hip and knee flexion in patients who had undergone THA.Methods49 subjects, 25 males 24 females, mean age of 73 years (range 51–80) with THA participated. All patients were measured with a portable IMU system, with sensors attached lateral to the pelvis, the thigh and the lower leg. For validation, a 12-camera motion capture system was used to determine the positions of 15 skin markers (Oqus 4, Qualisys AB, Sweden). Comparison of sagittal pelvic rotations, and hip and knee flexion-extension motions measured with the two systems was performed. The mean values of the IMU’s on the left and right sides were compared with OTS data.ResultsThe comparison between the two gait analysis methods showed no significant difference for mean pelvic tilt range (4.9–5.4 degrees) or mean knee flexion range (54.4–55.1 degrees) on either side (p > 0.7). The IMU system did however record slightly less hip flexion on both sides (36.7–37.7 degrees for the OTS compared to 34.0–34.4 degrees for the IMU, p < 0.001).ConclusionsWe found that inertial measurement units can produce valid kinematic data of pelvis- and knee flexion-extension range. Slightly less hip flexion was however recorded with the inertial measurement units which may be due to the difference in the modelling of the pelvis, soft tissue artefacts, and malalignment between the two methods or misplacement of the inertial measurement units.Trial registrationThe study has ethical approval from the ethical committee “Regionala etikprövningsnämnden i Göteborg” (Dnr: 611–15, 2015-08-27) and all study participants have submitted written approval for participation in the study.

The effect of intracortical bone pin on shoulder kinematics during dynamic activities

ABSTRACT Intracortical bone pins are introduced as gold standard for analysing skeletal motion because of eliminating soft tissue artefact. However, excluding this methodological error might be in cost of intervening movement pattern by local anaesthesia and pain of external tool within body. The purpose of this study was to examine whether intracortical bone pins alter shoulder joint kinematics or coordination. Three subjects were analysed during arm elevation/depression in frontal and sagittal planes. Retroreflective skin markers captured the motion in two sessions, before and after inserting bone pins (SKIN and PIN sessions), respectively. Thoracohumeral and scapulothoracic kinematics and scapulohumeral rhythm (SHR) were compared between two sessions. Thoracohumeral exhibited lower elevation and internal rotation in PIN session especially close to maximum arm elevation. The highest differences were observed for scapulothoracic kinematics, with higher retraction during abduction as well as higher posterior tilt, lateral rotation and retraction during flexion in PIN session. In addition, no systematic changes in SHR between subjects was found. Statistically significant lower SHR in PIN session was observed over 87-100% of thoracohumeral elevation/depression cycle in frontal plane and over 25-61% in sagittal plane. Further studies should treat carefully toward the clinical validity of shoulder joint kinematics after inserting bone pins.

Quantification of three-dimensional soft tissue artifacts in the canine hindlimb during passive stifle motion

BackgroundThree-dimensional joint kinematics during canine locomotion are commonly measured using skin marker-based stereophotogrammetry technologies. However, marker-related errors caused by the displacement of the skin surface relative to the underlying bones (i.e., soft tissue artifacts, STA) may affect the accuracy of the measurements and obscure clinically relevant information. Few studies have assessed STA in canine limbs during kinematic analysis. The magnitudes and patterns of the STA and their influence on kinematic analysis remain unclear. Therefore, the current study aims to quantify the in vivo STA of skin markers on the canine thigh and crus during passive joint motion. The stifle joints of ten dogs were passively extended while the skin markers were measured using a motion capture system, and skeletal kinematics were determined using a CT-to-fluoroscopic image registration method.ResultsThe skin markers exhibited considerable STA relative to the underlying bones, with a peak amplitude of 27.4 mm for thigh markers and 28.7 mm for crus markers; however, the amplitudes and displacement directions at different attachment sites were inconsistent. The markers on the cranial thigh and lateral crus closer to the stifle joint had greater STA amplitudes in comparison to those of other markers. Most markers had STA with linear and quadratic patterns against the stifle flexion angles. These STA resulted in underestimated flexion angles but overestimated adduction and internal rotation when the stifle was flexed to greater than 90°.ConclusionsMarker displacements relative to the underlying bones were prominent in the cranial aspect of the thigh and the proximal-lateral aspect of the crus. The calculated stifle kinematic variables were also affected by the STA. These findings can provide a reference for marker selection in canine motion analysis for similar motion tasks and clarify the relationship between STA patterns and stifle kinematics; the results may therefore contribute to the development of STA models and compensation techniques for canine motion analysis.

Effect of implementing magnetic resonance imaging for patient-specific OpenSim models on lower-body kinematics and knee ligament lengths

BackgroundOpenSim models are typically based on cadaver findings that are generalized to represent a wide range of populations, which curbs their validity. Patient-specific modelling through incorporating magnetic resonance imaging (MRI) improves the model’s biofidelity with respect to joint alignment and articulations, muscle wrapping, and ligament insertions. The purpose of this study was to determine if the inclusion of an MRI-based knee model would elicit differences in lower limb kinematics and resulting knee ligament lengths during a side cut task. MethodsEleven participants were analyzed with the popular Rajagopal OpenSim model, two variations of the same model to include three and six degrees of freedom knee (DOF), and a fourth version featuring a four DOF MRI-based knee model. These four models were used in an inverse kinematics analysis of a side cut task and the resulting lower limb kinematics and knee ligament lengths were analyzed. ResultsThe MRI-based model was more responsive to the movement task than the original Rajagopal model while less susceptible to soft tissue artifact than the unconstrained six DOF model. Ligament isometry was greatest in the original Rajagopal model and smallest in the six DOF model. ConclusionsWhen using musculoskeletal modelling software, one must acutely consider the model choice as the resulting kinematics and ligament lengths are dependent on this decision. The MRI-based knee model is responsive to the kinematics and ligament lengths of highly dynamic tasks and may prove to be the most valid option for continuing with late-stage modelling operations such as static optimization.

Bayesian inverse kinematics vs. least-squares inverse kinematics in estimates of planar postures and rotations in the absence of soft tissue artifact

A variety of inverse kinematics (IK) algorithms exist for estimating postures and displacements from a set of noisy marker positions, typically aiming to minimize IK errors by distributing errors amongst all markers in a least-squares (LS) sense. This paper describes how Bayesian inference can contrastingly be used to maximize the probability that a given stochastic kinematic model would produce the observed marker positions. We developed Bayesian IK for two planar IK applications: (1) kinematic chain posture estimates using an explicit forward kinematics model, and (2) rigid body rotation estimates using implicit kinematic modeling through marker displacements. We then tested and compared Bayesian IK results to LS results in Monte Carlo simulations in which random marker error was introduced using Gaussian noise amplitudes ranging uniformly between 0.2 mm and 2.0 mm. Results showed that Bayesian IK was more accurate than LS-IK in over 92% of simulations, with the exception of one center-of-rotation coordinate planar rotation, for which Bayesian IK was more accurate in only 68% of simulations. Moreover, while LS errors increased with marker noise, Bayesian errors were comparatively unaffected by noise amplitude. Nevertheless, whereas the LS solutions required average computational durations of less than 0.5 s, average Bayesian IK durations ranged from 11.6 s for planar rotation to over 2000 s for kinematic chain postures. These results suggest that Bayesian IK can yield order-of-magnitude IK improvements for simple planar IK, but also that its computational demands may make it impractical for some applications.

The impact of thigh and shank marker quantity on lower extremity kinematics using a constrained model

BackgroundMusculoskeletal models are commonly used to quantify joint motions and loads during human motion. Constraining joint kinematics simplifies these models but the implications of the placement and quantity of markers used during data acquisition remains unclear. The purpose of this study was to establish the effects of marker placement and quantity on lower extremity kinematics calculated using a constrained-kinematic model. We hypothesized that a constrained-kinematic model would produce lower-extremity kinematics errors that correlated with the number of tracking markers removed from the thigh and shank.MethodsHealthy-young adults (N = 10) walked on a treadmill at slow, moderate, and fast speeds while skin-mounted markers were tracked using motion capture. Lower extremity kinematics were calculated for 256 combinations of leg and shank markers to establish the implications of marker placement and quantity on joint kinematics. Marker combinations that yielded differences greater than 5 degrees were tested with paired t-tests and the relationship between number of markers and kinematic errors were modeled with polynomials to determine goodness of fit (R2).ResultsSagittal joint and hip coronal kinematics errors were smaller than documented errors caused by soft-tissue artifact, which tends to be approximately 5 degrees, when excluding thigh and shank markers. Joint angle and center kinematic errors negatively correlated with the number of markers included in the analyses (R2 > 0.97) and typically showed the greatest error reductions when two markers were included on the thigh or shank segments. Further, we demonstrated that a simplified marker set that included markers on the pelvis, lateral knee condyle, lateral malleolus, and shoes produced kinematics that strongly agreed with the traditional marker set that included 3 tracking markers for each segment.ConclusionConstrained-kinematic models are resilient to marker placement and quantity, which has implications on study design and post-processing workflows.

A new method of estimating scapular orientation during various shoulder movements: A comparison of three non-invasive methods

The conventional acromion marker cluster (AMC) method used to estimate scapular orientation cannot adequately represent complex shoulder movements due to soft tissue artifacts. The regression method may have nonlinear error changes depending on humeral elevation angle and elevation plane. Therefore, we aimed to develop a new method of estimating scapular orientation using curved surface interpolation during various shoulder movements, and to compare its accuracy with conventional and regression methods. Thirteen healthy men were recruited. AMC and refractive markers for bony landmarks were placed on the skin. During the preprocess, several shoulder postures, including different arm elevations and elevation planes, were measured using the motion capture system. Premeasured data were used to calibrate the positional relationship between AMC and scapula using curved surface interpolation. Subsequently, scapular orientations were estimated by measuring AMC and body markers of any shoulder posture. To evaluate the accuracy of our methods, 25 elevation postures and six tasks involving postures common to activities of daily living were applied. For tasks requiring greater arm elevation angles, the root mean square error was less in our method than in the conventional and regression methods. Therefore, our method could improve the accuracy of estimating scapular orientation in various elevation postures.

A Robust Methodology for the Reconstruction of the Vertical Pedestrian-Induced Load from the Registered Body Motion

This paper proposes a methodology to reconstruct the vertical GRFs from the registered body motion that is reasonably robust against measurement noise. The vertical GRFs are reconstructed from the experimentally identified time-variant pacing rate and a generalised single-step load model available in the literature. The proposed methodology only requires accurately capturing the body motion within the frequency range 1–10 Hz and does not rely on the exact magnitude of the registered signal. The methodology can therefore also be applied when low-cost sensors are used and to minimize the impact of soft-tissue artefacts. In addition, the proposed procedure can be applied regardless of the position of the sensor on the human body, as long as the recorded body motion allows for identifying the time of a nominally identical event in successive walking cycles. The methodology is illustrated by a numerical example and applied to an experimental dataset where the ground reaction forces and the body motion were registered simultaneously. The results show that the proposed methodology allows for arriving at a good estimate of the vertical ground reaction forces. When the impact of soft-tissue artefacts is low, a comparable estimate can be obtained using Newton’s second law of motion.

A Simple Algorithm for Assimilating Marker-Based Motion Capture Data During Periodic Human Movement Into Models of Multi-Rigid-Body Systems

Human movement analysis is often performed with a model of multi-rigid-body system, whereby reflective-marker-based motion capture data are assimilated into the model for characterizing kinematics and kinetics of the movements quantitatively. Accuracy of such analysis is limited, due to motions of the markers on the skin relative to the underlying skeletal system, referred to as the soft tissue artifact (STA). Here we propose a simple algorithm for assimilating motion capture data during periodic human movements, such as bipedal walking, into models of multi-rigid-body systems in a way that the assimilated motions are not affected by STA. The proposed algorithm assumes that STA time-profiles during periodic movements are also periodic. We then express unknown STA profiles using Fourier series, and show that the Fourier coefficients can be determined optimally based solely on the periodicity assumption for the STA and kinematic constraints requiring that any two adjacent rigid-links are connected by a rotary joint, leading to the STA-free assimilated motion that is consistent with the multi-rigid-link model. To assess the efficiency of the algorithm, we performed a numerical experiment using a dynamic model of human gait composed of seven rigid links, on which we placed STA-affected markers, and showed that the algorithm can estimate the STA accurately and retrieve the non-STA-affected true motion of the model. We also confirmed that our STA-removal processing improves accuracy of the inverse dynamics analysis, suggesting the usability of the proposed algorithm for gait analysis.

P 054–Evaluation of ground reaction forces by inverse dynamics analysis

Soft tissue artefact (STA) affects the kinematics retrieved with skin marker-based motion capture, and thus influences the outcomes of biomechanical models that rely on such kinematics. In order to be compensated for, the effects of STA must be characterized across a broad sample population and for different motion activities. In this study, the error introduced by STA on the kinematics of the hip joint and of its individual components, and on the location of the hip joint center (HJC) was quantified for fifteen THA subjects during overground gait, stair descent, chair rise and putting on socks. The error due to STA was computed as the difference between the kinematics measured with motion capture and those measured simultaneously with moving fluoroscopy, a STA-free X-ray technique. The main significant effects of STA were: underestimation of the hip range of motion for all four activities, underestimation of the flexion especially during phases of the motion with higher flexion, overestimation of the internal rotation, and lateral misplacement of the HJC mostly due to the functional calibration. The thigh contributed more to the STA error than the pelvis. The STA error of the thigh appeared to be correlated with the hip flexion angles, with a varying degree of linearity depending on the activity and on the phase of the motion cycle. Future kinematic-driven STA compensation models should take into account the non-linearity of the STA error and its dependency of the phase of the motion cycle.

Joint Center Estimation Using Single-Frame Optimization: Part 2: Experimentation.

Human motion capture is driven by joint center location estimates, and error in their estimation can be compounded by subsequent kinematic calculations. Soft tissue artifact (STA), the motion of tissue relative to the underlying bones, is a primary cause of error in joint center calculations. A method for mitigating the effects of STA, single-frame optimization (SFO), was introduced and numerically verified in Part 1 of this work, and the purpose of this article (Part 2) is to experimentally compare the results of SFO with a marker-based solution. The experimentation herein employed a single-degree-of-freedom pendulum to simulate human joint motion, and the effects of STA were simulated by affixing the inertial measurement unit to the pendulum indirectly through raw, vacuum-sealed meat. The inertial sensor was outfitted with an optical marker adapter so that its location could be optically determined by a camera-based motion-capture system. During the motion, inertial effects and non-rigid attachment of the inertial sensor caused the simulated STA to manifest via unrestricted motion (six degrees of freedom) relative to the rigid pendulum. The redundant inertial and optical instrumentation allowed a time-varying joint center solution to be determined both by optical markers and by SFO, allowing for comparison. The experimental results suggest that SFO can achieve accuracy comparable to that of state-of-the-art joint center determination methods that use optical skin markers (root mean square error of 7.87–37.86 mm), and that the time variances of the SFO solutions are correlated ( 0.58–0.99) with the true, time-varying joint center solutions. This suggests that SFO could potentially help to fill a gap in the existing literature by improving the characterization and mitigation of STA in human motion capture.

P261] Image quality assessment of filtered dual energy cone beam CT for radiotherapy

Purpose Dual energy (DE) computed tomography (CT), combines two scans obtained with different photon energy spectra. It is known from diagnostic CT to reduce metal artefacts. This study investigates the feasibility of developing a DE protocol for cone-beam CT (CBCT) in radiotherapy. Methods The DE efficacy depends on the ability to separate the energy spectra of the two scans. Therefore, different thickness of copper (Cu) filtration was added to the high energy scan. The DE CBCT scanning protocol consists of two scans at 80 (low) and 140 (high) kV, respectively. Two different DE protocols with 1 and 2 mm added Cu filtration were created. The filtration was done by physically adding Cu plates onto the kV source of the CBCT system. The mAs was adjusted to keep the doses of both DE protocols on the same level as the standard CBCT. The dose was measured using a CTDI phantom. The DE images, I DE , were created in image space from the high, I high , and low, I low , energy images using I DE ( E ) = w ( E ) ∗ I low + ( 1 - w ( E ) ) ∗ I high where w(E) is a weighting factor dependent on the (pseudo) monochromatic energy, E, of the I DE images. Scans of a Catphan phantom were acquired with the DE CBCT protocols as well as a standard CBCT scan at 100 kV. The Cu filtered DE CBCT scans were investigated with respect to soft tissue image quality as the potential benefit of image artefact reduction should not compromise overall image quality or increase radiation dose compared to the standard CBCT. To quantify the image quality, contrast-to-noise (CNR) measurements were done in regions resembling muscle and fat in the phantom. Results The radiation dose was 100.1% and 101.4% of the standard CBCT dose for the 1 and 2 mm Cu protocols, respectively. The CNR was found to be 1.3 (standard), 1.4 (DE, 1 mm Cu) and 1.3 (DE, 2 mm Cu). Conclusions The filtered DE and standard CBCT protocols showed similar performance in radiation dose and soft tissue image quality. Hence it is feasible to explore the potential benefits of increased soft tissue contrast and artefact reduction for DE CBCT protocols.

Influence of the moving fluoroscope on gait patterns.

Video-fluoroscopic analysis can provide important insights for the evaluation of outcome and functionality after total knee arthroplasty, allowing the in vivo assessment of tibiofemoral kinematics without soft tissue artefacts. To enable measurement of the knee throughout activities of daily living such as gait, robotic systems like the moving fluoroscope have been developed that follow the knee movement and maintain the joint in front of the image intensifier. Since it is unclear whether walking while being accompanied by moving fluoroscope affects normal gait, the objective of this study was to investigate its influence on gait characteristics in healthy subjects. In addition, the impact of the motors’ noise was analysed.By means of skin markers analysis (VICON MX system, Oxford Metrics Group, UK) and simultaneous measurement of ground reaction forces (Kistler force plates, Kistler, Switzerland), gait characteristics when walking with and without the moving fluoroscope as well as with and without ear protectors in combination with the moving fluoroscope, were obtained in young (n = 10, 24.5y ± 3.0y) and elderly (n = 9, 61.6y ± 5.3y) subjects during level gait and stair descent. Walking with the moving fluoroscope significantly decreased gait velocity in level gait and stair descent over the respective movement without the fluoroscope. Statistical analysis, including gait velocity as a covariate, resulted in no differences on the ground reaction force parameters. However, some kinematic parameters (ankle, knee and hip ranges of motion, minimal knee angle in late stance phase, maximal knee angles in stance and swing phase) seemed to be modified by the presence of the moving fluoroscope, but statistical comparison was limited due to velocity differences between the conditions. Wearing ear protectors to avoid the influence of motor sound during walking with the moving fluoroscope caused no significant difference.Walking with the moving fluoroscope has been shown to decrease gait velocity and small alterations in kinematic parameters were observed. Therefore, gait and movement alterations due to the moving fluoroscope cannot completely be excluded. However, based on the absence of differences in ground reaction force parameters (when adjusted for velocity within ANCOVA), as well as based on the comparable shape of the angular curves to the slow control condition, it can be concluded that changes in gait when walking with the moving fluoroscope are small, especially in comparison to natural slow walking. In order to allow assessment of joint replacement with the moving fluoroscope, including an understanding of the effects of joint pain, clinical analyses can only be compared to gait activities showing similarly reduced velocities. Importantly, the reduced gait speeds observed in this study are similar to those observed after total knee arthroplasty, suggesting that analyses in such subjects are appropriate. However, the moving fluoroscope would likely need to be optimized in order to detect natural gait characteristics at the higher gait velocities of healthy young subjects.The moving fluoroscope can be applied for comparisons between groups measured with the moving fluoroscope, but care should be taken when comparing data to subjects walking at self-selected speed without the moving fluoroscope.

O 068 – The variation of lateral and posterior coverage of the femoral head by the acetabulum during walking influences stability during gait

Gait balance,assessed by the angle formed between the line joining the center-of-mass (COM) to the center-of-pressure (COP) and the vertical during gait, has been shown to be related to skeletal-postural and anthro-pometric parameters [1]. Although skeletal-postural parameters are mea-sured on standing radiographs, they are known to vary during gait. There are currently no studies evaluating how the variations of skeletal-postural parameters during gait influence subject’s balance during walking. Research question How does the variation of skeletal-postural parameters during gait influence subject’s balance during walking? Methods 72 asymptomatic subjects (age: 28.6 ± 11 years [18–59], 29F) underwent 3D gait analysis [2] with additional markers on the thighs and shanks. The COM-COP angle with the vertical was calculated in both the frontal and sagittal planes during the gait cycle [3]( Fig. 1).Subjects then underwent low-dose full-body biplanar X-rays with themarkers still in place. 3D reconstructions were obtained for the spine,pelvis and lower limbs. 3D bones were registered at each frame of thegait cycle [4]. A new technique developed for this study, utilizingfiniteelement modelling, was used to reduce soft tissue artefacts. Skeletal-postural parameters were then computed during the gait cycle, using the 3D registered bones, at each time frame (Fig. 2); mean, minimum, maximum and ROM were calculated on the waveforms during the gaitcycle. In order to determine which varying skeletal-postural parameterduring gait determined the variation of the COM-COP angles, univariate analysis (Pearson’s correlation) followed by a multivariate analysis (stepwise-multiple-linear-regression models) were computed; COM-COP parameters were the dependant variables and varying skeletal-postural parameters during gait were the independent variables. Results Minimum (−14.2 ± 3.4°) and average (3.1 ± 1.6°) of the sagittal COM-COP angle were found to be determined by the minimum of the posterior coverage (post_cov) of the femoral head by the acetabulum during gait (β= 0.40; R2 = 0.16; p = 0.003 andβ= 0.32; R2 = 0.1;p = 0.001, respectively). ROM (33.9 ± 5.1°) and maximum(19.7 ± 2.8°) of the sagittal COM-COP angle were found to be related to the ROM (β= 0.29; R2 = 0.09; p = 0.03) and maximum (β= 0.34;R2 = 0.11; p = 0.006) of the acetabular abduction during gait, respectively. ROM of the frontal COM-COP angle (8.8 ± 2.51°) was found to be determined by the average of the post_cov (β= 0.51;R2 = 0.26; p = 0.004) during gait. Discussion This is the first study to evaluate how the variation of skeletal-postural parameters during walking influences the stability during gait(Fig. 3). A less pronounced posterior coverage of the acetabulum during gait predisposes to more instability by decreasing the minimum COM-COP angle; a more pronounced acetabular abduction (decreased lateralcoverage) during gait predisposes to more instability by increasing the ROM and the maximum of the COM-COP angle. Therefore, gait instability in the sagittal plane seems to be influenced by the variation of the posterior and lateral coverage of the femoral head by the acet-abulum during walking

Validity, Test-Retest Reliability and Long-Term Stability of Magnetometer Free Inertial Sensor Based 3D Joint Kinematics.

The present study investigates an algorithm for the calculation of 3D joint angles based on inertial measurement units (IMUs), omitting magnetometer data. Validity, test-retest reliability, and long-term stability are evaluated in reference to an optical motion capture (OMC) system. Twenty-eight healthy subjects performed a 6 min walk test. Three-dimensional joint kinematics of the lower extremity was recorded simultaneously by means of seven IMUs and an OptiTrack OMC system. To evaluate the performance, the root mean squared error (RMSE), mean range of motion error (ROME), coefficient of multiple correlations (CMC), Bland-Altman (BA) analysis, and intraclass correlation coefficient (ICC) were calculated. For all joints, the RMSE was lower than 2.40°, and the ROME was lower than 1.60°. The CMC revealed good to excellent waveform similarity. Reliability was moderate to excellent with ICC values of 0.52–0.99 for all joints. Error measures did not increase over time. When considering soft tissue artefacts, RMSE and ROME increased by an average of 2.2° ± 1.5° and 2.9° ± 1.7°. This study revealed an excellent correspondence of a magnetometer-free IMU system with an OMC system when excluding soft tissue artefacts.

O 024—Joint loading is normalized following single-event multilevel surgery and partly normalized following botulinum injections in cerebral palsy patients

Motion assessment of the body’s head-arms-trunk (HAT) using linked-segment models, along with an inverse dynamics approach, can enable in vivo estimations of inter-vertebral moments. However, this mathematical approach is prone to experimental errors because of inaccuracies in (i) kinematic measurements associated with soft tissue artifacts and (ii) estimating individual-specific body segment parameters (BSPs). The inaccuracy of the BSPs is particularly challenging for the multi-segment HAT due to high inter-participant variability in the HAT’s BSPs and no study currently exists that can provide a less erroneous estimation of the joint moments along the spinal column.This study characterized three-dimensional (3D) inter-segmental moments in a multi-segment HAT model during multi-directional trunk-bending, after minimizing the experimental errors.Eleven healthy individuals participated in a multi-directional trunk-bending experiment in five directions with three speeds. A seven-segment HAT model was reconstructed for each participant, and its motion was recorded. After compensating for experimental errors due to soft tissue artifacts, and using optimized individual-specific BSPs, and center of pressure offsets, the inter-segmental moments were calculated via inverse dynamics.Our results show a significant effect of the inter-segmental level and trunk-bending directions on the obtained moments. Compensating for soft tissue artifacts contributed significantly to reducing errors. Our results indicate complex, task-specific patterns of the 3D moments, with high inter-participant variability at different inter-segmental levels, which cannot be studied using single-segment models or without error compensation.Interpretation of inter-segmental moments after compensation of experimental errors is important for clinical evaluations and developing injury prevention and rehabilitation strategies.

Quantification of multi-segment trunk kinetics during multi-directional trunk bending

BackgroundMotion assessment of the body’s head-arms-trunk (HAT) using linked-segment models, along with an inverse dynamics approach, can enable in vivo estimations of inter-vertebral moments. However, this mathematical approach is prone to experimental errors because of inaccuracies in (i) kinematic measurements associated with soft tissue artifacts and (ii) estimating individual-specific body segment parameters (BSPs). The inaccuracy of the BSPs is particularly challenging for the multi-segment HAT due to high inter-participant variability in the HAT’s BSPs and no study currently exists that can provide a less erroneous estimation of the joint moments along the spinal column. Research questionThis study characterized three-dimensional (3D) inter-segmental moments in a multi-segment HAT model during multi-directional trunk-bending, after minimizing the experimental errors. MethodEleven healthy individuals participated in a multi-directional trunk-bending experiment in five directions with three speeds. A seven-segment HAT model was reconstructed for each participant, and its motion was recorded. After compensating for experimental errors due to soft tissue artifacts, and using optimized individual-specific BSPs, and center of pressure offsets, the inter-segmental moments were calculated via inverse dynamics. ResultsOur results show a significant effect of the inter-segmental level and trunk-bending directions on the obtained moments. Compensating for soft tissue artifacts contributed significantly to reducing errors. Our results indicate complex, task-specific patterns of the 3D moments, with high inter-participant variability at different inter-segmental levels, which cannot be studied using single-segment models or without error compensation. SignificanceInterpretation of inter-segmental moments after compensation of experimental errors is important for clinical evaluations and developing injury prevention and rehabilitation strategies.