Hans Kainz

Joint kinematic calculation based on clinical direct kinematic versus inverse kinematic gait models.

Most clinical gait laboratories use the conventional gait analysis model. This model uses a computational method called Direct Kinematics (DK) to calculate joint kinematics. In contrast, musculoskeletal modelling approaches use Inverse Kinematics (IK) to obtain joint angles. IK allows additional analysis (e.g. muscle-tendon length estimates), which may provide valuable information for clinical decision-making in people with movement disorders. The twofold aims of the current study were: (1) to compare joint kinematics obtained by a clinical DK model (Vicon Plug-in-Gait) with those produced by a widely used IK model (available with the OpenSim distribution), and (2) to evaluate the difference in joint kinematics that can be solely attributed to the different computational methods (DK versus IK), anatomical models and marker sets by using MRI based models. Eight children with cerebral palsy were recruited and presented for gait and MRI data collection sessions. Differences in joint kinematics up to 13° were found between the Plug-in-Gait and the gait 2392 OpenSim model. The majority of these differences (94.4%) were attributed to differences in the anatomical models, which included different anatomical segment frames and joint constraints. Different computational methods (DK versus IK) were responsible for only 2.7% of the differences. We recommend using the same anatomical model for kinematic and musculoskeletal analysis to ensure consistency between the obtained joint angles and musculoskeletal estimates.

Accuracy and reliability of marker-based approaches to scale the pelvis, thigh, and shank segments in musculoskeletal models

Gait analysis together with musculoskeletal modeling is widely used for research. In the absence of medical images, surface marker locations are used to scale a generic model to the individuals anthropometry. Studies evaluating the accuracy and reliability of different scaling approaches in a pediatric and/or clinical population have not yet been conducted and, therefore, formed the aim of this study. Magnetic resonance images (MRI) and motion capture data were collected from 12 participants with cerebral palsy and 6 typically developed participants. Accuracy was assessed by comparing the scaled models segment measures to the corresponding MRI measures, whereas reliability was assessed by comparing the models segments scaled with the experimental marker locations from the first and second motion capture session. The inclusion of joint centers into the scaling process significantly increased the accuracy of thigh and shank segment length estimates compared to scaling with markers alone. Pelvis scaling approaches which included the pelvis depth measure led to the highest errors compared to the MRI measures. Reliability was similar between scaling approaches with mean ICC of 0.97. The pelvis should be scaled using pelvic width and height and the thigh and shank segment should be scaled using the proximal and distal joint centers.

Effects of hip joint centre mislocation on gait kinematics of children with cerebral palsy calculated using patient-specific direct and inverse kinematic models

Joint kinematics can be calculated by Direct Kinematics (DK), which is used in most clinical gait laboratories, or Inverse Kinematics (IK), which is mainly used for musculoskeletal research. In both approaches, joint centre locations are required to compute joint angles. The hip joint centre (HJC) in DK models can be estimated using predictive or functional methods, while in IK models can be obtained by scaling generic models. The aim of the current study was to systematically investigate the impact of HJC location errors on lower limb joint kinematics of a clinical population using DK and IK approaches. Subject-specific kinematic models of eight children with cerebral palsy were built from magnetic resonance images and used as reference models. HJC was then perturbed in 6mm steps within a 60mm cubic grid, and kinematic waveforms were calculated for the reference and perturbed models. HJC perturbations affected only hip and knee joint kinematics in a DK framework, but all joint angles were affected when using IK. In the DK model, joint constraints increased the sensitivity of joint range-of-motion to HJC location errors. Mean joint angle offsets larger than 5° were observed for both approaches (DK and IK), which were larger than previously reported for healthy adults. In the absence of medical images to identify the HJC, predictive or functional methods with small errors in anterior-posterior and medial-lateral directions and scaling procedures minimizing HJC location errors in the anterior-posterior direction should be chosen to minimize the impact on joint kinematics.

Reliability of functional and predictive methods to estimate the hip joint centre in human motion analysis in healthy adults

In human motion analysis predictive or functional methods are used to estimate the location of the hip joint centre (HJC). It has been shown that the Harrington regression equations (HRE) and geometric sphere fit (GSF) method are the most accurate predictive and functional methods, respectively. To date, the comparative reliability of both approaches has not been assessed. The aims of this study were to (1) compare the reliability of the HRE and the GSF methods, (2) analyse the impact of the number of thigh markers used in the GSF method on the reliability, (3) evaluate how alterations to the movements that comprise the functional trials impact HJC estimations using the GSF method, and (4) assess the influence of the initial guess in the GSF method on the HJC estimation. Fourteen healthy adults were tested on two occasions using a three-dimensional motion capturing system. Skin surface marker positions were acquired while participants performed quite stance, perturbed and non-perturbed functional trials, and walking trials. Results showed that the HRE were more reliable in locating the HJC than the GSF method. However, comparison of inter-session hip kinematics during gait did not show any significant difference between the approaches. Different initial guesses in the GSF method did not result in significant differences in the final HJC location. The GSF method was sensitive to the functional trial performance and therefore it is important to standardize the functional trial performance to ensure a repeatable estimate of the HJC when using the GSF method.

Instantaneous progression reference frame for calculating pelvis rotations: Reliable and anatomically-meaningful results independent of the direction of movement

In motion analysis, pelvis angles are conventionally calculated as the rotations between the pelvis and laboratory reference frame. This approach assumes that the participants motion is along the anterior-posterior laboratory reference frame axis. When this assumption is violated interpretation of pelvis angels become problematic. In this paper a new approach for calculating pelvis angles based on the rotations between the pelvis and an instantaneous progression reference frame was introduced. At every time-point, the tangent to the trajectory of the midpoint of the pelvis projected into the horizontal plane of the laboratory reference frame was used to define the anterior-posterior axis of the instantaneous progression reference frame. This new approach combined with the rotation-obliquity-tilt rotation sequence was compared to the conventional approach using the rotation-obliquity-tilt and tilt-obliquity-rotation sequences. Four different movement tasks performed by eight healthy adults were analysed. The instantaneous progression reference frame approach was the only approach that showed reliable and anatomically meaningful results for all analysed movement tasks (mean root-mean-square-differences below 5°, differences in pelvis angles at pre-defined gait events below 10°). Both rotation sequences combined with the conventional approach led to unreliable results as soon as the participants motion was not along the anterior-posterior laboratory axis (mean root-mean-square-differences up to 30°, differences in pelvis angles at pre-defined gait events up to 45°). The instantaneous progression reference frame approach enables the gait analysis community to analysis pelvis angles for movements that do not follow the anterior-posterior axis of the laboratory reference frame.

O 053 - Femoral deformities affect gait performance more than hip muscle weakness

Four hundred models were created with varying FA, NSA and muscle weakness, for one healthy child (9 years), based on marker trajectories (Vicon, Oxford Metrics, UK) and ground reaction forces (AMTI, Watertown, MA) measured during gait and starting from a scaled generic musculoskeletal model (SIMM, Motion Analysis Corp., Santa Rosa, CA). In each of the models, the FA and NSA were increased, in steps of 10° from 20° to 60° and from 120° to 160°, respectively. In all created models, the maximal isometric muscle force of the rectus femoris, gluteus maximus, gluteus medius, psoas or biceps femoris was decreased by 0% to 75% in steps of 25%. A reference gait pattern was calculated for the original scaled model based on the measured marker trajectories in Opensim 3.3, which was imposed to all models. Next, muscle forces were calculated using static optimization. If muscle forces were unable to restore the moment balance, reserve actuators were activated. These indicate the capability gap, i.e. the gap between the required hip joint torques for normal gait and the maximal joint torque the muscles could produce. A regression analysis related the FA, NSA and hip muscle weakness to the maximal absolute capability gap for the hip.