Can the evaluation of marker placement confidence be used as an indicator of gait kinematic variability?

IntroductionThree-dimensional gait analysis is widely used for the clinical assessment of movement disorders. However, measurement error reduces the reliability of kinematic data and consequently assessment of gait deviations. The identification of high variability is associated with low reliability and those parameters should be ignored or excluded from gait data interpretation. Moreover, marker placement error has been demonstrated to be the biggest source of variability in gait analysis and may be affected by factors intrinsic to the evaluators such as the evaluator's expertise which could be appraised through his/her experience and confidence in marker placement.ObjectivesIn the present study, we hypothesized that confidence in marker placement is correlated with kinematic variability and could potentially be used as part of a score of reliability. Therefore, we have proposed a questionnaire to evaluate qualitatively the confidence of evaluators in lower-limb marker placement. The primary aim of this study was to evaluate the reliability and validity of the presented questionnaire. The secondary objective was to test a possible relationship between marker placement confidence and kinematics variability.MethodsTo do so, test-retest gait data were acquired from two different experimental protocols. One protocol included data from a cohort of 32 pathological and 24 asymptomatic subjects where gait analysis was repeated three times, involving two evaluators. A second protocol included data from a cohort of 8 asymptomatic adults with gait analysis repeated 12 times, per participant, and involving four evaluators with a wider range of experience.ResultsResults demonstrated that the questionnaire proposed is valid and reliable to evaluate qualitatively the confidence of evaluators in placing markers. Indeed, confidence scores were correlated with the actual variability of marker placement and revealed the evaluator's experience and the subjects' characteristics. However, no correlation was observed between confidence scores and kinematic variability and the formulated hypothesis was not supported

Towards a multimodal analysis of European Piano Schools of Music Performance

This study aims to characterize representative performances by experienced pianists in order to determine main influential trends in performance, derived specifically from traditional piano practices referred to as National Piano Schools. The methodology of this exploratory study departs from a musicological empirical analysis in articulation with recent technological developments for metric methods. It allowed an analysis of gesture and musical semantics by applying a multimodal approach for capturing the pianist performance based on the extraction of features’ sets specifically targeted to each piano school. In this paper we describe the quantitative analysis approach based on motion capture.info:eu-repo/semantics/publishedVersio

Covid-19 vaccinations : the unknowns, challenges and hopes

The entire world has been suffering from the coronavirus disease 2019 (COVID‐19) pandemic since March 11, 2020. More than a year later, the COVID‐19 vaccination brought hope to control this viral pandemic. Here, we review the unknowns of the COVID‐19 vaccination, such as its longevity, asymptomatic spread, long‐term side effects, and its efficacy on immunocompromised patients. In addition, we discuss challenges associated with the COVID‐19 vaccination, such as the global access and distribution of vaccine doses, adherence to hygiene guidelines after vaccination, the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) variants, and vaccine resistance. Despite all these challenges and the fact that the end of the COVID‐19 pandemic is still unclear, vaccines have brought great hope for the world, with several reports indicating a significant decline in the risk of COVID19‐related infection and hospitalizations.peer-reviewe

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018) : Change management in allergic rhinitis and asthma multimorbidity using mobile technology

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.Peer reviewe

Quantification, réduction et gestion de la variabilité cinématique dans l'analyse clinique de la marche

The doctoral work here presented intends to improve the quality of measured gait data directed to the application in clinical gait analysis and is divided into three main objectives. The first objective is to quantify the variability caused by measurement error. Within this objective, and since marker placement is considered as the main source of variability, the first two studies evaluated the impact of simulated marker displacement in the output kinematics. Complementarily, a third study evaluated experimentally the precision of marker placement among different evaluators as well as the associated variability on the kinematic data. Finally, the fourth study reported an analytical model that was also developed to understand the propagation of error when defining the axes of the joint coordinate system and to separate intrinsic and extrinsic variabilities (i.e. axes of the joint coordinate system versus helical axis of the movement). The results showed that the emblematic cross-talk phenomenon (i.e. erroneous amplitude of knee adduction-abduction during swing phase) can be attributed to both intrinsic and extrinsic variabilities. The second objective of this thesis focused on reducing the variability caused by measurement error. Within this, one study compared the variability calculated within the test-retest experimental protocol when applying different biomechanical models and two calibration methods. Additionally, another study proposed a new developed method that to accurately estimate gait events based on auto-correlation and auto-selection among concurrent models. The proposed method used the vertical force from the force platform to detect gait events, when gait events are valid on the platform (single foot completely within the limits of the platform during the complete gait cycle), and take those events to create several algorithms based on auto-correlation as well as to automatically select the method that best performs from all methods implemented. Finally, the third main objective was to evaluate new possibilities to improve the management of the variability in clinical gait analysis. After reducing and quantifying the variability associated with measurement error, it is important to bridge this information with the clinical interpretation. Thus, the goal was to incorporate expected measurement variability into the gait data reports. Associated to this objective, two studies are currently under preparation and described. Firstly, one study proposed a metric to collect marker placement confidence on a qualitatively way. Quality of this metrics in terms of validity and reliability has been made with the support of two test-retest experimental protocols. Finally, the preliminary work on the development of a new gait score considering clinically relevant features of kinematics and expected variability is presented. Through this doctoral work, the high complexity of the link between the sources of measurement error and the kinematic variability was a big challenge. However, the work developed brought up a better quantification and understanding of how measurement error such as marker placement or axes definition is translated to the output kinematic data variability. Therefore, such information has the potential to be integrated within clinical interpretation in order to provide higher confidence in the identification and interpretation of gait deviations. Finally, the Conventional Gait Model was the base model for the work developed during the complete thesis due to the fact that it is the most accepted model in the clinical context. However, most of results can be reproduced using different biomechanical models.Le travail de doctorat ici présenté vise à améliorer la qualité des données de marche mesurées destinées à l'application dans l'analyse clinique de la marche et se divise en trois objectifs principaux. Le premier objectif est de quantifier la variabilité causée par l'erreur de mesure. Dans cet objectif, et puisque le placement des marqueurs est considéré comme la principale source de variabilité, les deux premières études ont évalué l'impact du déplacement simulé des marqueurs sur la cinématique de sortie. En complément, une troisième étude a évalué expérimentalement la précision du placement des marqueurs parmi différents évaluateurs ainsi que la variabilité associée sur les données cinématiques. Enfin, la quatrième étude a rapporté un modèle analytique qui a également été développé pour comprendre la propagation de l'erreur lors de la définition des axes du système de coordonnées articulaires et pour séparer les variabilités intrinsèques et extrinsèques (c'est-à-dire les axes du système de coordonnées articulaires par rapport à l'axe hélicoïdal du mouvement). Le deuxième objectif de cette thèse portait sur la réduction de la variabilité causée par l'erreur de mesure. Dans ce cadre, une étude a comparé la variabilité calculée dans le cadre du protocole expérimental test-retest lors de l'application de différents modèles biomécaniques et de deux méthodes d'étalonnage. De plus, une autre étude a proposé une nouvelle méthode développée pour estimer avec précision les événements de marche basés sur l'auto-corrélation et l'auto-sélection parmi les modèles concurrents. La méthode proposée utilise la force verticale de la plate-forme de force pour détecter les événements de marche, lorsque les événements de marche sont valides sur la plate-forme (pied unique complètement dans les limites de la plate-forme pendant le cycle de marche complet), et utilise ces événements pour créer plusieurs algorithmes basés sur sur l'auto-corrélation ainsi que pour sélectionner automatiquement la méthode la plus performante parmi toutes les méthodes mises en œuvre. Enfin, le troisième objectif principal était d'évaluer de nouvelles possibilités pour améliorer la gestion de la variabilité dans l'analyse clinique de la marche. Après avoir réduit et quantifié la variabilité associée à l'erreur de mesure, il est important de relier cette information à l'interprétation clinique. Ainsi, l'objectif était d'intégrer la variabilité de mesure attendue dans les rapports de données sur la marche. Associées à cet objectif, deux études sont actuellement en préparation et décrites. Premièrement, une étude a proposé une métrique pour collecter la confiance du placement des marqueurs de manière qualitative. La qualité de cette métrique en termes de validité et de fiabilité a été réalisée à l'aide de deux protocoles expérimentaux test-retest. Enfin, les travaux préliminaires sur le développement d'un nouveau score de marche prenant en compte les caractéristiques cliniquement pertinentes de la cinématique et la variabilité attendue sont présentés. A travers ce travail doctoral, la grande complexité du lien entre les sources d'erreur de mesure et la variabilité cinématique était un défi de taille. Cependant, les travaux développés ont permis de mieux quantifier et comprendre comment les erreurs de mesure telles que le placement des marqueurs ou la définition des axes sont traduites en variabilité des données cinématiques de sortie. Par conséquent, ces informations ont le potentiel d'être intégrées dans l'interprétation clinique afin de fournir une plus grande confiance dans l'identification et l'interprétation des déviations de la marche. Enfin, le modèle de marche conventionnelle a été le modèle de base pour les travaux développés au cours de la thèse complète du fait qu'il s'agit du modèle le plus accepté dans le contexte clinique. Cependant, la plupart des résultats peuvent être reproduits à l'aide de différents modèles biomécaniques

Quantification, réduction et gestion de la variabilité cinématique dans l'analyse clinique de la marche

Le travail de doctorat ici présenté vise à améliorer la qualité des données de marche mesurées destinées à l'application dans l'analyse clinique de la marche et se divise en trois objectifs principaux. Le premier objectif est de quantifier la variabilité causée par l'erreur de mesure. Dans cet objectif, et puisque le placement des marqueurs est considéré comme la principale source de variabilité, les deux premières études ont évalué l'impact du déplacement simulé des marqueurs sur la cinématique de sortie. En complément, une troisième étude a évalué expérimentalement la précision du placement des marqueurs parmi différents évaluateurs ainsi que la variabilité associée sur les données cinématiques. Enfin, la quatrième étude a rapporté un modèle analytique qui a également été développé pour comprendre la propagation de l'erreur lors de la définition des axes du système de coordonnées articulaires et pour séparer les variabilités intrinsèques et extrinsèques (c'est-à-dire les axes du système de coordonnées articulaires par rapport à l'axe hélicoïdal du mouvement). Le deuxième objectif de cette thèse portait sur la réduction de la variabilité causée par l'erreur de mesure. Dans ce cadre, une étude a comparé la variabilité calculée dans le cadre du protocole expérimental test-retest lors de l'application de différents modèles biomécaniques et de deux méthodes d'étalonnage. De plus, une autre étude a proposé une nouvelle méthode développée pour estimer avec précision les événements de marche basés sur l'auto-corrélation et l'auto-sélection parmi les modèles concurrents. La méthode proposée utilise la force verticale de la plate-forme de force pour détecter les événements de marche, lorsque les événements de marche sont valides sur la plate-forme (pied unique complètement dans les limites de la plate-forme pendant le cycle de marche complet), et utilise ces événements pour créer plusieurs algorithmes basés sur sur l'auto-corrélation ainsi que pour sélectionner automatiquement la méthode la plus performante parmi toutes les méthodes mises en œuvre. Enfin, le troisième objectif principal était d'évaluer de nouvelles possibilités pour améliorer la gestion de la variabilité dans l'analyse clinique de la marche. Après avoir réduit et quantifié la variabilité associée à l'erreur de mesure, il est important de relier cette information à l'interprétation clinique. Ainsi, l'objectif était d'intégrer la variabilité de mesure attendue dans les rapports de données sur la marche. Associées à cet objectif, deux études sont actuellement en préparation et décrites. Premièrement, une étude a proposé une métrique pour collecter la confiance du placement des marqueurs de manière qualitative. La qualité de cette métrique en termes de validité et de fiabilité a été réalisée à l'aide de deux protocoles expérimentaux test-retest. Enfin, les travaux préliminaires sur le développement d'un nouveau score de marche prenant en compte les caractéristiques cliniquement pertinentes de la cinématique et la variabilité attendue sont présentés. A travers ce travail doctoral, la grande complexité du lien entre les sources d'erreur de mesure et la variabilité cinématique était un défi de taille. Cependant, les travaux développés ont permis de mieux quantifier et comprendre comment les erreurs de mesure telles que le placement des marqueurs ou la définition des axes sont traduites en variabilité des données cinématiques de sortie. Par conséquent, ces informations ont le potentiel d'être intégrées dans l'interprétation clinique afin de fournir une plus grande confiance dans l'identification et l'interprétation des déviations de la marche. Enfin, le modèle de marche conventionnelle a été le modèle de base pour les travaux développés au cours de la thèse complète du fait qu'il s'agit du modèle le plus accepté dans le contexte clinique. Cependant, la plupart des résultats peuvent être reproduits à l'aide de différents modèles biomécaniques.The doctoral work here presented intends to improve the quality of measured gait data directed to the application in clinical gait analysis and is divided into three main objectives. The first objective is to quantify the variability caused by measurement error. Within this objective, and since marker placement is considered as the main source of variability, the first two studies evaluated the impact of simulated marker displacement in the output kinematics. Complementarily, a third study evaluated experimentally the precision of marker placement among different evaluators as well as the associated variability on the kinematic data. Finally, the fourth study reported an analytical model that was also developed to understand the propagation of error when defining the axes of the joint coordinate system and to separate intrinsic and extrinsic variabilities (i.e. axes of the joint coordinate system versus helical axis of the movement). The results showed that the emblematic cross-talk phenomenon (i.e. erroneous amplitude of knee adduction-abduction during swing phase) can be attributed to both intrinsic and extrinsic variabilities. The second objective of this thesis focused on reducing the variability caused by measurement error. Within this, one study compared the variability calculated within the test-retest experimental protocol when applying different biomechanical models and two calibration methods. Additionally, another study proposed a new developed method that to accurately estimate gait events based on auto-correlation and auto-selection among concurrent models. The proposed method used the vertical force from the force platform to detect gait events, when gait events are valid on the platform (single foot completely within the limits of the platform during the complete gait cycle), and take those events to create several algorithms based on auto-correlation as well as to automatically select the method that best performs from all methods implemented. Finally, the third main objective was to evaluate new possibilities to improve the management of the variability in clinical gait analysis. After reducing and quantifying the variability associated with measurement error, it is important to bridge this information with the clinical interpretation. Thus, the goal was to incorporate expected measurement variability into the gait data reports. Associated to this objective, two studies are currently under preparation and described. Firstly, one study proposed a metric to collect marker placement confidence on a qualitatively way. Quality of this metrics in terms of validity and reliability has been made with the support of two test-retest experimental protocols. Finally, the preliminary work on the development of a new gait score considering clinically relevant features of kinematics and expected variability is presented. Through this doctoral work, the high complexity of the link between the sources of measurement error and the kinematic variability was a big challenge. However, the work developed brought up a better quantification and understanding of how measurement error such as marker placement or axes definition is translated to the output kinematic data variability. Therefore, such information has the potential to be integrated within clinical interpretation in order to provide higher confidence in the identification and interpretation of gait deviations. Finally, the Conventional Gait Model was the base model for the work developed during the complete thesis due to the fact that it is the most accepted model in the clinical context. However, most of results can be reproduced using different biomechanical models

Impact of lateral epicondyle marker misplacement on kinematics using the Conventional Gait Model - A sensitivity study

ESMAC2019, 28th Annual Meeting of European Society of Movement Analysis for Adults and Children, Amsterdam, PAYS-BAS, 23-/09/2019 - 28/09/2019Consistent marker placement is a key factor on the reliability of clinical gait analysis (CGA). D.Croce et al. reported an inter-examiner variability up to 19.2 mm on the lateral epicondyle (LE) marker, used for definition of femur and tibia coordinate systems. Large misplacements may lead to improper results (> 5° deviation) and so it is important to understand the accuracy required to obtain reliable results. The Conventional Gait Model (CGM) is extensively used in CGA. Among literature referring the impact of markers misplacement, Szczerbik et al. experimentally shifted LE marker (14 mm) around its position and reported changes on hip and ankle kinematics up to 10° and 25° on the sagittal and transversal plane respectively, and knee up to 18° and 20° in sagittal and frontal plane espectively

Sensitivity of conventional gait model to lower limb marker misplacement

ESMAC 2020 - Annual meeting of the European Society of Movement Analysys for Adults and children, -, -, 17-/09/2020 - 17/09/2020The Conventional Gait Model is an extensively used model in clinical gait analysis (CGA). The repeatability of CGA is a key factor for providing reliable data to support clinical decision making. Marker misplacement is a predominant factor contributing to kinematic errors. A marker misplacement of 6?25?mm was reported in a test-retest study

The Conventional Gait Model's sensitivity to lower-limb marker placement

Clinical gait analysis supports treatment decisions for patients with motor disorders. Measurement reproducibility is affected by extrinsic errors such as marker misplacement?considered the main factor in gait analysis variability. However, how marker placement affects output kinematics is not completely understood. The present study aimed to evaluate the Conventional Gait Model's sensitivity to marker placement. Using a dataset of kinematics for 20 children, eight lower-limb markers were virtually displaced by 10mm in all four planes, and all the displacement combinations were recalculated. Root-mean-square deviation angles were calculated for each simulation with respect to the original kinematics. The marker movements with the greatest impact were for the femoral and tibial wands together with the lateral femoral epicondyle marker when displaced in the anterior-posterior axis. When displaced alone, the femoral wand was responsible for a deviation of 7.3° (±?1.8°) in hip rotation. Transversal plane measurements were affected most, with around 40% of simulations resulting in an effect greater than the acceptable limit of 5°. This study also provided insight into which markers need to be placed very carefully to obtain more reliable gait data

The impact of internet addiction on the mental health of college students from the central area of Portugal

Introduction: Mental health has an imperative roll in general health, and it’s known that most mental and physical diseases are influenced by a combination of biological, psychological and social factors, in which takes place the Internet addiction. Objectives: identify the sociodemographic variables that influence the mental health of college students; identify academic variables that influence the mental health of college student. Methods: Quantitative, descriptive-analytical and cross-sectional study with 511 college students of the Central Region of Portugal. It was used a questionnaire on sociodemographic and academic context, and were used the following scales: Mental Health Scale – PhD José Luís Pais Ribeiro (2011); Internet Addiction Test, Portuguese version by Pontes e Patrão (2013). Results: Mostly female students, standing largely in the age group of 17-21 years, living in urban areas, with an average family income. Younger students have high addition to the internet (62.2%). Sex interfere with the mental health of students. The lower the negative impact of adding Internet emotions / feelings and lower its negative impact on daily life, the less anxiety, depression and loss of emotional / behavioral control of college students. The negative impact on daily life establishes a direct relationship with the positive affect, indicating that the greater the negative impact, less positive affect students. Conclusions: The results obtained point to the need to implement mental health programs, by conducting two workshops, promoting social interaction among students, to help them find more effective ways to respond to the daily challenges