Estimation and validation of temporal gait features using a markerless 2D video system

Background and Objective: Estimation of temporal gait features, such as stance time, swing time and gait cycle time, can be used for clinical evaluations of various patient groups having gait pathologies, such as Parkinson’s diseases, neuropathy, hemiplegia and diplegia. Most clinical laboratories employ an optoelectronic motion capture system to acquire such features. However, the operation of these systems requires specially trained operators, a controlled environment and attaching reflective markers to the patient’s body. To allow the estimation of the same features in a daily life setting, this paper presents a novel vision based system whose operation does not require the presence of skilled technicians or markers and uses a single 2D camera. Method: The proposed system takes as input a 2D video, computes the silhouettes of the walking person, and then estimates key biomedical gait indicators, such as the initial foot contact with the ground and the toe off instants, from which several other temporal gait features can be derived. Results: The proposed system is tested on two datasets: (i) a public gait dataset made available by CASIA, which contains 20 users, with 4 sequences per user; and (ii) a dataset acquired simultaneously by a marker-based optoelectronic motion capture system and a simple 2D video camera, containing 10 users, with 5 sequences per user. For the CASIA gait dataset A the relevant temporal biomedical gait indicators were manually annotated, and the proposed automated video analysis system achieved an accuracy of 99% on their identification. It was able to obtain accurate estimations even on segmented silhouettes where, the state-of-the-art markerless 2D video based systems fail. For the second database, the temporal features obtained by the proposed system achieved an average intra-class correlation coefficient of 0.86, when compared to the "gold standard" optoelectronic motion capture system. Conclusions: The proposed markerless 2D video based system can be used to evaluate patients’ gait without requiring the usage of complex laboratory settings and without the need for physical attachment of sensors/markers to the patients. The good accuracy of the results obtained suggests that the proposed system can be used as an alternative to the optoelectronic motion capture system in non-laboratory environments, which can be enable more regular clinical evaluations.info:eu-repo/semantics/acceptedVersio

Markerless Kinematics of Pediatric Manual Wheelchair Mobility

Pediatric manual wheelchair users face substantial risk of orthopaedic injury to the upper extremities, particularly the shoulders, during transition to wheelchair use and during growth and development. Propulsion strategy can influence mobility efficiency, activity participation, and quality of life. The current forefront of wheelchair biomechanics research includes translating findings from adult to pediatric populations, improving the quality and efficiency of care under constrained clinical funding, and understanding injury mechanisms and risk factors. Typically, clinicians evaluate wheelchair mobility using marker-based motion capture and instrumentation systems that are precise and accurate but also time-consuming, inconvenient, and expensive for repeated assessments. There is a substantial need for technology that evaluates and improves wheelchair mobility outside of the laboratory to provide better outcomes for wheelchair users, enhancing clinical data. Advancement in this area gives physical therapists better tools and the supporting research necessary to improve treatment efficacy, mobility, and quality of life in pediatric wheelchair users. This dissertation reports on research studies that evaluate the effect of physiotherapeutic training on manual wheelchair mobility. In particular, these studies (1) develop and characterize a novel markerless motion capture-musculoskeletal model systems interface for kinematic assessment of manual wheelchair propulsion biomechanics, (2) conduct a longitudinal investigation of pediatric manual wheelchair users undergoing intensive community-based therapy to determine predictors of kinematic response, and (3) evaluate propulsion pattern-dependent training efficacy and musculoskeletal behavior using visual biofeedback.Results of the research studies show that taking a systems approach to the kinematic interface produces an effective and reliable system for kinematic assessment and training of manual wheelchair propulsion. The studies also show that the therapeutic outcomes and orthopaedic injury risk of pediatric manual wheelchair users are significantly related to the propulsion pattern employed. Further, these subjects can change their propulsion pattern in response to therapy even in the absence of wheelchair-based training, and have pattern-dependent differences in joint kinematics, musculotendon excursion, and training response. Further clinical research in this area is suggested, with a focus on refining physiotherapeutic training strategies for pediatric manual wheelchair users to develop safer and more effective propulsion patterns

A machine learning approach for clinical gait analysis and classification of polymyalgia rheumatica using myoelectric sensors

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonThe study focuses on Polymyalgia Rheumatica (PMR), an autoimmune musculoskeletal disease primarily affecting the shoulder blade and hip muscles in older adults, particularly women aged 50 and above. The research aims to address two main challenges: the need for more clarity on the disease's pathophysiology and the challenge of identifying disease severity in patients. The study introduces a novel approach involving movement assessment, by designing a low-cost MyoTracker system, and using electromyography (EMG) features to understand the impact on patients' hip muscles. A clinical trial was conducted at Komfo Anokye Teaching Hospital in Ghana, where the study employed a qualitative research approach to monitor movement patterns. Participants were tasked to perform exercises comprising of gait, knee lifting, and knee extension with sensors attached to the hip muscles. This research unfolds in three iterations, the first investigation involved hip muscular imbalances where the significant difference between patients and healthy controls in the maximum voluntary contraction (MVC) values was recorded. The bilateral difference computed between the left and right hip in patients exhibited 15% MVC on average compared to the healthy control group's 6%, indicating substantial hip muscular imbalances. The second iteration involved a movement assessment to identify specific movement patterns in patients. Support Vector Machine (SVM) achieves 85% accuracy for gait exercises, while Decision Tree (DT) performs less efficiently at 70%. SVM also excels in knee lifting exercises (70% accuracy), outperforming DT (60%). Based on hip muscle activation, patients' movement patterns significantly differ from healthy controls. In the third iteration, deep learning techniques, specifically RNN-LSTM and Vision Transformer (ViT), classify PMR disease severity based on EMG features. The study's results carry significant clinical implications with the evidence of hip muscular imbalances aiding in designing tailored rehabilitation protocols. Importantly, this study uses a cost-effective method for determining disease severity, enabling predictions about patients with severe PMR conditions. The key contribution of this thesis is the identification of patients’ specific movement patterns and the determination of PMR severity among patients. Other contributions are the detection of hip muscular imbalance in patients and the design of rehabilitation protocols to address hip muscular imbalances and improve patients' range of motion, enhancing overall well-being. In conclusion, this comprehensive study leverages innovative approaches, from a MyoTracker system for movement assessment to deep learning models, to unravel the complexities of PMR disease. The collaboration with medical experts emphasises the potential real-world impact of this research in enhancing the treatment and recovery processes for individuals.Ghana Scholarship Secretaria

Систем за подршку одлучивању, евалуацију и праћење стања пацијената оболелих од неуродегенеративних болести

Системи за подршку клиничком одлучивању представљају рачунарске алате који применом напредних технологија могу утицати на доношење одлука у вези са пацијентима. У овој дисертацији представљени су истраживање и развој новог система за подршку одлучивању, евалуацију и праћење стања пацијената оболелих од неуродегенеративних болести. Анализа клинички релевантних и свакодневних покрета чини основу овог система. Обрасци ових покрета снимљени су помоћу бежичних, носивих сензора малих димензија и тежине, који не захтевају компликовану поставку и могу се једноставно применити у било ком окружењу. Први део система намењен је (раном) препознавању Паркинсонове болести (ПБ) на основу анализе хода и алгоритама дубоког учења. Резултати су показали да је ПБ пацијенте могуће препознати са високом тачношћу. Други део система посвећен је праћењу симптома ПБ брадикинезије применом резоновања који се базира на знању. Представљена је метода за анализу покрета који се користе за евалуацију брадикинезије. Поред тога, применом различитих метода обраде сигнала развијена је нова метрика за квантификацију важних карактеристика ових покрета. Предикција степена развоја симптома се заснива на новом експертском систему који у потпуности објективизује клиничке евалуационе критеријуме. Валидација је урађена на примеру покрета тапкања прстију, који је снимљен на пацијенатима са типичним и атипичним паркинсонизимом. Показана је висока усаглашеност у поређењу са клиничким подацима. Развијени систем је објективан, аутоматизован, једноставно се користи, садржи интуитиван графички и параметарски приказ резултата и значајно доприноси унапређењу клиничких процедура за евалуацију и праћење стања пацијената са неуродегенеративним болестима.Clinical decision support system represents a computer-aided tool that utilizes advanced technologies for influencing clinical decisions about patients. This dissertation presents research and development of a new decision support system for the assessment of patients with neurodegenerative diseases. The analysis of movements that are part of standard clinical scales or everyday activities represents the basis of the system. These movements are recorded using small and lightweight wearable, wireless sensors, which do not require complicated setup and can be easily applied in any environment. The first part of system is dedicated to the (early) recognition of Parkinson’s disease (PD) based on gait analysis and deep learning algorithms. PD patients could be identified with a high accuracy. The other part of the system is dedicated to the assessment of PD symptoms, more specifically, bradykinesia, utilizing the knowledge-based reasoning. A method for analysis of bradykinesia related movements is defined and presented. Moreover, by applying different signal processing techniques, new metrics have been developed to quantify the essential characteristics of these movements. The prediction of symptom severity was performed using new expert system that completely objectified the clinical evaluation criteria. Validation was performed on the example of the finger-tapping movement of patients with typical and atypical parkinsonism. A high compliance rate was obtained compared to clinical data. The developed system is objective, automated, easy to use, contains an intuitive graphical and parametric presentation of results, and significantly contributes to the improvement of clinical assessment of patients with neurodegenerative diseases