BM 1282 BALA BINNY NP

Journal of Biomechanics 33 (2000) 1207}1216

Movement biomechanics goes upwards: from the leg to the arm

G. Rau, C. Disselhorst-Klug*, R. Schmidt
Helmholtz-Institute for Biomedical Engineering, Aachen University of Technology, Pauwelsstr. 20, 52074 Aachen, Germany
Accepted 1 March 2000

Abstract

The analysis of lower limb movements has been well established in biomechanics research and clinical applications for a long time.
For these studies, powerful and very advanced tools have been developed to measure movement parameters and reaction forces. The
main focus of interest aims towards gait movements while the understanding of the basic concepts is supported by numerous models.
De"nitions of physiological ranges and detection of pathological changes in movements open an increasingly valuable clinical "eld of
application. If, however, the primary function of the upper extremities as highly variable and adaptive organ for manipulating tasks is
the subject of interest, the situation becomes considerably more complex. The nature of free arm movements is completely di!erent
from being restricted, repeatable or cyclic as compared to gait. Therefore, the transfer of the knowledge and experience gained in lower
extremity movement analysis to the analysis of upper extremities turns out to be di$cult. A proposal for how to proceed in
measurements, e.g. where to place the markers and how to calculate movements and angles of segments involved, will be discussed
which results in the description of the joint movements of wrist, elbow and shoulder joint. The de"nition of the motion is a speci"c step
in upper extremity motion analysis which is important in terms of repeatability and signi"cance of the results. An example of assessing
movement disorders in children with plexus lesion will illustrate the implications and the potential of upper extremity movement
analysis in clinical applications.  2000 Elsevier Science Ltd. All rights reserved.

1. Introduction 3D motion analysis has turned out to be a powerful

Biomechanics of movement is * to a large extent
* the application of Newtonian mechanics to the neuro-
muscular skeletal system: the forces that cause the move-
ment, and the internal forces that act within the body.
Movement analysis has been developed since about 1900
and speci"cally pushed during the last 30 yr by better
insight in the living organisms supported by tremendous
advances in research. Typical areas concern: Cellular
function (metabolism, structure, mechanical properties,
dynamic behavior), muscle, bone, ligaments, tendons,
cartilage properties, neuromuscular control mechanisms.
Also, dedicated biomechanical and sensorimotor control
models have been established and re"ned. This increase
in knowledge has been achieved by very advanced experi-
ment procedures and equipment which is well described
in various books and publications.
* Corresponding author. Tel.: #49-241-807011; fax: #49-241-
8888442.
E-mail address: disselhorst-klug@hia.rwth-aachen.de (C. Dissel-
horst-Klug).
tool for a quantitative assessment of the movement in all
degrees of freedom. The early research on 3D motion
analysis was mainly focused on the improvement of
imaging techniques and 3D reconstruction algorithms in
order to get an accurate and reliable tool for the detec-
tion of three-dimensional free body movements. How-
ever, the "rst developments had only little practical
application. The breakthrough of 3D motion analysis in
clinical application can be attributed to clinical gait anal-
ysis where it is now applied to the detailed diagnosis and
treatment planning of patients with di$culties in gait.
This is not surprising since gait is a well-de"ned motion
type with cyclic sequences repetitive from heelstrike-to-
heelstrike. Several biomechanical models of the lower
extremities have been developed allowing the calculation
of joint angles, joint forces and moments as well as the
work, the power or the energy. For movement detection,
"rst applicable optoelectronic systems for gait analysis
have been introduced in the early seventies and have
been developed into reliable tools. Although they are still
expensive their accuracy, speed and convenience made
them into a standard measurement tool (Whittle, 1982).
Thus, after more than 100 yr of technical development,

0021-9290/00/$ - see front matter  2000 Elsevier Science Ltd. All rights reserved.
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1208 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216
3D motion analysis has succeeded to be a useful clinical
tool in gait analysis (Whittle, 1995).
Recently, a number of gait laboratories have been
established in which gait abnormalities can be examined
precisely. The transition from normal gait to moderate
disorders that may end up with severely disturbed move-
ment patterns which can hardly be classi"ed or connec-
ted to gait because the individuals may not be able to
walk anymore. In#uences of pathological changes, and
even structural deformations, have to be considered.
Muscles may be a!ected by disease, such as dystrophy,
arthrophy or pain reactions. Fibrous tissue contracture
after surgical and reconstructive operations, as well as
ligament or tendon diseases or cartilage injuries, may
limit passive mobility. Injury of brain, spinal or peri-
pheral nerve structures may disrupt motor control and
feed back pathways. To overcome these de"ciencies, fre-
quently alternative motions are developed by the patient.
These are only a few aspects which may generate a per-
son's walking pattern into a mixture of primary func-
tional loss and substitutional actions.
However, the clinical use of gait laboratories is rapidly
increasing. One of the most popular clinical application
of gait analysis is the use for diagnostic and surgical
planning in treatment of children with spastic paralysis in
which the orthopedic surgeons are the driving forces.
However, presently, clinical applications take place
mainly in those centres where a strong collaboration
between clinicians and engineers is established. The
available equipment and procedures can only be
utilized by specialists but cannot be introduced into
clinical routine * a big challenge for future development.
Another obstacle to the clinical use is the lack of
standardized, consistent and liable data banks which are
necessary for interpreting the clinical signi"cance of the
measurements.
Analysis of the upper extremities is at an early stage,
and introduction to clinical routine seems to be a step for
the future. The use of the upper extremities in daily life is
versatile as can be indicated by a few examples: we use
tools, grasp, perform complex manipulations, we throw
objects, point, gesticulate, etc., by using arms and hands
in a coordinated and well-organised way. For analysis of
such movements, the experience from decades of gait
analysis is not readily transferable. In this context,
a working group of the International Society of
Biomechanics (ISB) has been established, specialising in
shoulder movement and dealing with one of the most
complicated joints. The variety, complexity and range of
upper-extremity movements is a big challenge to assess-
ment and interpretation of data, getting even more com-
plicated in clinical application.
To tackle this problem, the advanced developments in
gait analysis could be a guideline for how to proceed in
the upper extremity movement analysis. On the basis of
the well-established procedures in gait analysis, one
could develop possible approaches for the three-dimen-
sional analysis of free upper-extremity movements.
2. Motion analysis of gait
Normal gait is well de"ned in each individual. The gait
cycle shows a typical pattern which remains unchanged
for subjects older than 4 yr (Sutherland et al., 1988).
Especially the timing of the gait cycle has been described
in detail, (Inman et al., 1981; Perry, 1992; Whittle, 1991)
among others. Gait is a cyclic sequence of movements
occurring from heelstrike to heelstrike of the same foot.
Also, it is to a high degree symmetrical, and each cycle is
highly reproducible. The interindividual variations are
rather small, and this "nally allows to establish a refer-
ence for normal gait.
Each gait cycle can be roughly divided into the swing
phase and the stance phase of each leg. The stance phase
is about 60% of the gait cycle and can be subdivided into
double-leg and single-leg stance. The swing phase of the
leg consists of three phases: initial swing, where the leg is
accelerated, midswing and terminal swing, where the leg
is decelerated (Inman, 1966). The position of the feet on
the ground de"nes a number of gait parameters which
are commonly used for description of gait and which can
be easily obtained without the support of 3D motion
analysis (Table 1).
For each subject, the timing of gait and the character-
istic gait parameters are highly repeatable. Therefore, the
synchronised data of each gait cycle can be averaged to
improve the reliability of the extracted parameters. In
this way, a normative database has been set up, which
contains the information about the timing and the char-
acteristic parameters of the physiological gait (Murray,
1967).
Most of the characteristic gait parameters can be mea-
sured when the movement of the trunk and the feet are
traced. The available 3D movement analysis systems are
suitable, and standardised procedures for the positioning
of limb markers are established. Derived from the 3D
Table 1
Characteristic parameters describing the individual gait pattern
(Whittle, 1995)
Parameter De"nition
Cadence Number of steps per time
Walking velocity Distance walked per time
Step length Distance by which each foot is in front
of the other one
Stride length Distance which each foot moves forward
in one gait cycle
Walking base Side-to-side distance between the two feet
Toe out angle angle between midline of the foot and
direction of walk
 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216 1209

trajectories of the markers, stick "gures can be created

which re#ect the positions of the limbs during the gait
cycle. However, since the stick "gures only show what
can also be seen by eye, the real advantage of 3D motion
analysis consists of its capacity to calculate joint angles
from the marker trajectories. In contrast to the stick
"gures, which only have very limited clinical application,
joint angles are parameters which are closely related to
the functions of muscles and joints. The combination of
the available 3D movement analysis systems, standar-
dised marker arrangements and an underlying mechan-
ical model of the limb segments allows the calculation of
the joint angles in all three dimensions. Most of these
kinematic models of the lower extremities assume that
the body is composed of rigid segments which are con-
nected by ideal links. This approach suggests to assign
one rigid segments to every bone (Andrews, 1995). How
to design such a kinematic model will be shown for the
upper-extremity movements in the next section. Utilising
joint angles, a kinematic description of gait can be
achieved. Although the kinematic description of gait has
been introduced some time ago, normative data are still
not completely available. Only for movements in the
sagittal plane, a normative database about the joint
Fig. 1. Di!erent ways of the description of human gait. The more
angles has been collected (Perry, 1974). This is due to the complex the description becomes the higher are the requirements to the
fact that the greatest range of the motion occurs in the recording set up and the underlying models. Since simpli"cations have
sagittal plan, and movements in the coronal and trans- to be made with each increment of complexity, the resulting interpreta-
verse plane are often neglected. However, although tion of the parameters have to be used more carefully.
the kinematic description of gait by means of joint angles
is commonly used in basic as well as in clinically orien-
tated research, the information about the joint angles to the sagittal plane, which results in a comparatively
is still rarely used in clinical routine. The reason is, simple motion, it is not possible to "nd a unique solution
that the clinical de"nitions of 3D-joint movements, like for the large number of equations which have to be
#exion}extension, abduction}adduction and internal} ful"lled by the model. For that reason, simplifying as-
external rotation, often di!er from those joint angles sumptions have to be made which are more or less
calculated by the kinematic model. That circum- correct (Whittle, 1995).
stance makes the interpretation of the kinematic data If the masses of the di!erent limb segments, their
di$cult and the information is often useless for clinical centres of gravity and their moments of inertia are
routine. known, the work, power and energy transfer between the
The information about the kinetics of gait has more di!erent body segments can be calculated. Although this
importance for clinical application. The transition from information is of high relevance for clinical applications,
the kinematic description of motion to a kinetic descrip- there is only little correspondence between the received
tion needs the measurement of the forces provided by the information and the physiological work or the metabolic
neuromuscular system (Fig. 1) (Nigg and Herzog, 1994). activity. Muscles, for example, need metabolic activity
In gait analysis, these forces are commonly measured by even during excentric contractions, and the tendons and
means of forceplates which detect the ground-reaction ligaments store passive energy which is not regarded in
forces. If kinematics and forces are detected in a common most models. Therefore, the calculated information about
co-ordinate system, they can be used as input into work, energy and power have to be handled with care.
a mathematical model which calculates, e.g. joint Besides the mechanical aspects in clinical gait analysis,
moments and joint forces, (Bresler and Franke, 1950; information about the muscular coordination is of clini-
Cavagna and Magaria, 1966). In contrast to the kin- cal relevance. This can be achieved by using electromyo-
ematic description, the kinetic description of gait pro- graphy (EMG) in which the electrical activity generated
vides powerful research tools with signi"cant meaning in by a contracting muscle is detected. The large number of
clinical application. However, the evidence of the kinetic muscles involved in gait and the dynamic contractions
description is limited by the underlying biomechanical require the use of surface electrodes. The problem
model. Even if the motion during the gait cycle is limited herewith is that EMG is only semi-quantitative. The
1210 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216
measured EMG amplitude depends not only on physio-
logical properties like the thickness of the tissue layers
between the muscle and the electrodes or the electrical
impedance of the skin, but it also depends on the
measurement arrangement, like the interelectrode dis-
tance or the location of the electrodes relative to the
muscle. Additionally, cross-talk of muscles located dis-
tantly from the muscle of interest has to be avoided.
Recently, within the European project SENIAM (surface
EMG for non-invasive assessment of muscles), recom-
mendations for electrodes and electrode placements have
been worked out in order to improve the quality and
reliability of surface EMG measurements (Disselhorst-
Klug and Rau, 1996; Hermens and Freriks, 1997). How-
ever, if the timing of the muscles is of interest, surface-
EMG is the only suitable tool to examine the &guilty
motor pattern' in gait (Winter, 1985).
3. Upper extremities
Comparing gait analysis to upper-extremity analysis
(Table 2) reveals the nature of the problems when
biomechanics goes from the leg to the arm.
E The variability of upper-extremity movements makes
the selection of one or more movements necessary.
These may be movements taken from an activity under
investigation or movements which are designed for the
experiment. The demands for accuracy and details, as
well as the way of interpretation and visualisation,
may vary for each application.
E Time normalisation and averaging based on the cyclic
nature of gait is generally not applicable to the upper
extremities. Inter- and intraindividual comparisons
are thus more di$cult.
E A 2D lateral view of gait yields a good approximation
of the major movement components. Upper-extremity
motions cannot be described in 2D. The 3D rotations
occurring at the shoulder lead to non-intuitive descrip-
tions of the rotational kinematics.
E Force plates and foot pressure soles provide accurate
data about the external forces during gait and running.
Table 2
Comparison of the situation in gait analysis and upper extremity
analysis
Gait analysis Upper extremities
One standard movement Task-dependent movements
Cyclic Non-cyclic
Approx. 2D 3D
External forces easily measurable External forces di$cult to access
Limited range of motion Extremely large range of motion
Standard protocols exist No standard protocols
Ready-to-use systems available No adapted systems available
Net joint forces and moments can be calculated from
the external forces since they are big compared to
gravity and inertia. In contrast, the assessment of
external hand forces is di$cult in most situations.
Furthermore, there are frequently no external forces,
and thus, only estimates of gravitational and inertial
force are available for the &determination' of joint
forces and moments. Therefore, kinetics description is
even less accurate for the upper extremities than the
lower extremities.
E The large range of movements increases the problem
of skin and soft tissue movements which is the
major limitation of the accuracy of all measurement
techniques which use skin-mounted sensors. Special
attention needs to be paid to the large rotations
around the longitudinal segment axes, not known
from gait.
E The variability and complexity of the tasks performed
with the upper extremity has prevented the establish-
ment of reliable and standardised procedures for the
measurement of upper-extremity movements by the
scienti"c community. As a consequence readily usable
tools are not commercially available.
The standards mentioned are not only necessary for
the development of commercial tools. They provide the
basis for the comparability and repeatability of results
which is even more important for the future of the "eld.
Therefore, the ISB promotes the de"nition of standards
in motion analysis in order to bundle and accelerate the
process. Standardisation proposals have been submitted
by several research groups for the hand, the wrist, the
elbow and the shoulder (http://isb.ri.ccf.org/standards/).
The standards yet do not de"ne a measurement proced-
ure but they give guidelines.
A measurement procedure for the upper extremities
must be #exible and accurate since it has to cover a wide
range of applications with very di!erent motion types
and varying accuracy requirements. A proposal of
a marker-based measurement procedure for upper-ex-
tremity motions which ful"ls these demands is presented
in the following (Schmidt et al., 1998,1999).
The analysis of the upper extremities starts on a com-
mon methodological platform with gait analysis. At "rst,
a kinematic model is needed which describes what is to
be measured. The kinematic model of the upper extremi-
ties is based on the rigid segment approach in which each
segment is assigned to one bone. However, scapula and
clavicle are not accessible with skin-mounted markers.
Therefore, the kinematic structure of the model is simpli-
"ed by omitting the scapula and connecting the clavicle
directly to the humerus (Schmidt et al., 1998). The same
problem occurs with the forearm. Ulna and radius are
indistinguishable by external markers. One forearm seg-
ment with the pro-/supination realised at the elbow joint
replaces the natural structure of two bones and two
 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216
Fig. 2. Kinematic structure of the model of the upper-extremities.
radioulnar joints. The resulting kinematic structure of
the upper-body is shown in Fig. 2.
The model is made up of nine segments: the hands, the
forearms, the upper-arms, the collarbones and the tho-
rax. The joints in this model are ideal and ball-and-
socket joints which do not permit translations between
the segment. Since the ball-joints do not have distinct
axes one co-ordinate system which is "xed in the prox-
imal segment is assigned to every joint. Each co-ordinate
axis then represents one joint axis. This implies
orthogonal joint axes which means an additional simpli-
"cation of the model (Schmidt et al., 1998, Schmidt et al.,
1999).
The kinematic model needs to be transformed into
a measurement set-up. All segments except the collar-
bone are de"ned by a set of at least three non-collinear
markers. By means of triplets of markers the motions of
each segment in all six degrees of freedom (dof) are
assessed. The best correspondence between model and
measurement is achieved when the three markers of one
triplet are rigidly interconnected in order to suppress
inter-marker motions due to skin movements.
The de"nition of the joint co-ordinate systems is more
complicated. Joint co-ordinate systems are a central issue
of the existing standardisation proposals of ISB men-
tioned above. However, these de"nitions are based on
bony landmarks which makes it impossible to directly
implement it by skin markers. Even placing the markers
above bony landmarks may not yield a good approxima-
tion because skin movement still disturbs the marker
position.
The proposed approach for upper-extremity analysis
uses a combination of three di!erent procedures to deter-
1211
Fig. 3. Marker con"guration with segment (dark) and joint (light)
markers. The marker triads of one segment may be connected by cu!s
in order to reduce intermarker motions (after Schmidt et al., 1998).
mine joint co-ordinate systems from marker measure-
ments:
Procedure 1: Additional markers are used to de"ne the
joint co-ordinate system of the wrist and the centre of the
elbow. It is su$cient, and more accurate, to use these
additional markers only during an extra static trial,
because skin movement is largest at the joints. The
markers are placed on the #exion/extension axes of
the joints (Fig. 3). At the elbow, they just indicate the
joint centre taken at the half-way between both markers.
At the wrist, the joint centre, as well as the orientation of
the #exion axis, is deduced from these markers. At the
wrist, the anatomical axes are not clearly de"ned since
the wrist joint is made up of several smaller interacting
joints. Accordingly, the marker-de"ned axes correspond
to the three basic functional axes more than to bony
structures. The longitudinal axis is "xed at the joint
centres of wrist and elbow. The #exion/extension axis
is perpendicular to this axis and within the plane made
up by the elbow centre and the wrist markers. The
abduction axis then follows from the requirement of
orthogonal axes.
Procedure 2: The centre of the shoulder joint is cal-
culated from a de"ned extra motion and an additional
static trail. This is because the shoulder joint is located
deep below the surface which hides most bony landmarks
necessary for a static determination of the joint centre.
Here, an evaluation of the movements of the upper-arm
markers with respect to the thorax markers by an opti-
misation procedure is more reliable. A simple example
would be to calculate the best "t of the centre of the
spheres the upper-arm markers are moving on with re-
1212 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216

spect to the thorax. More sophisticated optimisations decomposition is not determined at certain points (singu-
take into account motions of the shoulder girdle. The larities or gimbal lock). At these points, the resulting
result is an estimate of the position of the glenohumeral angles can jump 1803 although the joint movement is
head "xed in the upper-arm segment. only small.
Procedure 3: The orientation of the shoulder co-ordi-
nate system is actually arbitrary since no functional axes
exist. Instead the main body axes are applied. Therefore, 4. Normal movement
the thorax markers can be used to de"ne the orientation
of the shoulder co-ordinate system. The two upper The meaning of Euler/Cardan angles is explained in
markers yield the transversal #exion/extension axis. The the following example of a motion of the complete arm.
sagittal abduction axis is parallel to the perpendicular on Fig. 5 shows the shoulder and elbow angles measured
the marker plane. The longitudinal axis follows from the while the index "nger moved three times on a triangular
condition of orthogonal axes. trajectory in a paracoronal plane (Fig. 4).
The elbow co-ordinate system is calculated from the The joint angles of shoulder and elbow recorded dur-
shoulder centre. The longitudinal axis is given by ing that movement are displayed in Fig. 5. The "rst
the shoulder and the elbow centre which is known from curves display the #exion (#) and extension (!), the
the static trial with additional markers. The #exion/ second curves show abduction (#) and adduction (!)
extension axis is parallel to the perpendicular on the and the third curves the internal (#) and external (!)
plane de"ned by the joint centres of shoulder, elbow and rotation pronation (#) and supination (!), respective-
wrist. This de"nition is more robust in most cases than to ly. All angles are zero at the neutral position which is the
use the elbow markers. Measurements of the internal and straight arm hanging vertically and the palm pointing
external rotations of the upper-arm are by far more forwards. However, as in this example, the starting posi-
accurate with this method. However, the de"nition is tion of the measurements is not the neutral position. At
inaccurate when the arm is close to a straight line. This time zero, the hand is already in front of the chest. The
can be handled by "xing the elbow co-ordinate system at arm attitude at time 3 s in relation to the neutral position
the upper-arm (markers) when the reliable range (#exion is reached by a 953 elbow #exion and 1153 pronation. The
'153) is left, until the arm returns to a su$cient large shoulder is "rst #exed 503, then abducted around the new
#exion angle. abduction axis by 353, and "nally rotated internally
After having de"ned the joint co-ordinate systems, the around the current upper-arm axis by 503.
joint motions can be described as relative rotations be- The proposed procedure is the counterpart corre-
tween these co-ordinate systems. Shoulder rotations are sponding to existing procedures for gait analysis. It yields
rotations of the humerus-"xed elbow co-ordinate system
with respect to the clavicula-"xed shoulder co-ordinate
system. Elbow rotations are rotations of the forearm
"xed wrist co-ordinate system with respect to the elbow
coordinate system. Wrist rotations are rotations of the
hand segment coordinate system with respect to the wrist
co-ordinate system.
The joint rotations can be expressed in several di!erent
ways. The possibilities are helical axis, quaternions, Joint
Coordinate System (JCS) and Euler/Cardan angles. Since
Euler/Cardan angles are commonly used in gait analysis
and the JCS is equivalent to a special case of Eu-
ler/Cardan angles (Nigg and Herzog, 1994), they have
been employed in the following study.
Euler/Cardan angles are obtained when the total rota-
tions between the joint co-ordinate systems, usually given
as the so-called rotation matrices, are decomposed into
ordered sequences of rotations around the three joint
axes. There are exactly 12 di!erent possible orders. We
chose the one which is equivalent to the JCS, because it
best re#ects the anatomical meaning of the rotation
names. The order of rotations around axes "xed in the
distal segment is: (1) #exion/extension, (2) abduction/ad- Fig. 4. Trajectory of the index "nger resulting from the joint move-
duction and (3) rotation around the longitudinal segment ments of shoulder and elbow shown in Fig. 5. At time 3 s the index
axis. The disadvantage of Euler/Cardan angles is that the "nger is in the shown position.
 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216
Fig. 5. Shoulder and elbow angles during a triangular hand path.
a complete 3D description of upper-extremity move-
ments over the full range of motions.
5. Pathological movement
First clinical applications are illustrated by a measure-
ment of a child su!ering from a plexus lesion, caused by
a birth trauma (Fig. 6). Motion analysis is used in this
case to answer quite the same questions as gait analysis
does for cerebral paresis children. How is the range of
motion and the motion pattern altered due to the impair-
ment? In combination with surface electromyography,
the muscle co-ordination during the movements can be
assessed. This enables to answer separately whether the
e!ects of missing innervation, co-contraction or a mech-
anical block of the joint are responsible for the de"cit.
This is crucial information for the planning of conserva-
tive and surgical therapies.
The movements which were tested are abduction, elev-
ation, and a hand motion from the knee to the mouth
(cookie test). Fig. 6 shows a child during the cookie test.
In addition to the re#ecting markers, EMG electrodes
are visible at the upper-arm and the shoulder. The
motion pattern of the a!ected side (Fig. 7, right curves) is
clearly di!erent from the healthy side (Fig. 7, left curves).
The movement of the handicapped arm is, in general,
slow and irregular. The surface-EMG indicates that this
could be a result of co-contraction of the biceps and the
triceps. Shoulder #exion is smaller and jerkier. The
pronation seems to be barely controlled which causes
large variations of that joint angle.
In summary, the movement analysis of the upper-
extremities, as proposed here, provides information
which is relevant for clinical decision making. It gives
detailed insight into the complex motion patterns of the
1213
upper-extremities and can be related to muscle coordina-
tion via EMG recordings.
6. Conclusions and outlook
As mentioned above, in routine biomechanics ana-
lyses, gait may be considered as a gross movement with
joints of limited degrees of freedom involved. The spatial
dynamic movement patterns are frequently and satisfac-
torily assessed by a 2D-observation, and in special cases,
this has been extended to 3D-analysis. Standardized
equipment and procedures in gait analysis are elaborate
and available. Kinematic and kinetic models have been
developed in order to assess joint angles, joint forces, and
moments. If masses, centres of gravity, and moments of
inertia are available, work, energy and power can be
calculated. Besides the limiting simpli"cations made in
the models, the movement of gait can be described almost
completely. Although the movement of upper extremities
is much more complicated, it has been shown that some
of the knowledge from gait analysis can be used in the
analyses of upper-extremity motions. However, in both
lower and upper-extremity movement some basic ques-
tions and some restrictions in application are still pres-
ent.
7. Basic questions
Movements can be considered from various point of
views. First of all, they are observed as motion in time
and space. The observation can be re"ned by adequate
measurement procedures and equipment as a time-vary-
ing imagery or image sequence. Understanding the
movements needs a model-based description, but also an
1214 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216

Fig. 6. Measurement of upper-extremity movements of a child su!ering from a plexus lesion.

adequate biomechanical model. It is not su$cient to
generate a computer model of the human body as utilized
presently in synthetically animated movies where rigid
body parts connected by rotary joints with 1, 2 or 3
degrees of freedom are used (Hodgins, 1998; Hodgins
et al., 1998; Dubois and Huang, 1998). So far, it has some
natural look but still does not teach us the underlying
mechanisms and properties of the biomechanics.
As already mentioned, gait movements have been ana-
lyzed thoroughly on the basis of measurements with high
accuracy, and the interpretation supported by bio-
mechanical models is very advanced. Recently, re"ned
models which also include the main muscles involved are
being developed. However, gait movements are well de-
"ned, and the joints' characteristics can be simpli"ed
adequately for a gross movement description. Of course,
if one looks into the biomechanics of the knee &micro-
scopically' the situation may become very complicated.
In essence, gait analysis and interpretation by modeling
is already well developed.
Similarly, for a better understanding of upper-extrem-
ity movements, we need an adequate model approach
where the knowledge of the shoulder joint movement is
an integral part. Everybody who is familiar with the
 G. Rau et al. / Journal of Biomechanics 33 (2000) 1207}1216
Fig. 7. Comparison of the healthy arm (left) with the handicapped arm (right). The joint motions of the a!ected side are slower and jerkier.
anatomy, muscle mechanics, viscoelastic elements, and
sensory}motor control will tend to ask: Are there solu-
tions existing at all in such over-de"ned systems?
8. Restriction by application
Of course, if a very high precision is requested, the
problems will pile up exponentially. Therefore, one can
look into speci"c applications and then design movement
patterns to be performed by the subject accordingly in
such a way that we can get answers to our questions. It is
well known that repetitive movements with the
arm/hand/"nger system can be executed highly repro-
ducibly; even time and amplitude invariance have been
described in literature.
Interesting "elds of application are in Ergonomics
and in Medicine. Again, the free arm}hand}"nger
gesture movements as input media in man}machine
interaction need a rather high-resolution recognition of
the movements but not a biomechanical model. Hand-
tracking algorithms have been demonstrated already
during the Telekon Fair in Geneva in 1995, and recently,
"rst commercial products have become available which
are utilized for man}machine communications by
gestures.
Medical applications are speci"cally embedded in cli-
nical routine and, therefore, need to ful"ll some di!erent
characteristics. The "rst requirement which has to be
ful"lled is that the detected movement is repeatable with
high reliability. This does not necessarily mean high
precision, but the results must be comparable, indepen-
dent of the investigating clinic. As a consequence, a
certain degree of standardization is indispensable. This
situation becomes more complicated if movement analy-
sis has to be introduced into clinical routine. All tasks
have to be simple, easy to be applied, reliable, not
time consuming, and clear in the result. The personnel
1215
involved is critical: how many minutes of a doctor, a
technician or nurse are necessary? The duration of
a measurement is also essential because patients,
especially children and elderly persons, may not be
loaded very much, dependent on their de"ciencies. And
some of the patients are, in principle, not able to
reproduce a movement at all as, e.g., in the case of
spasticity. Here, completely di!erent procedures of
pattern recognition have to be developed. In spastic
phenomena, primarily not dramatic deformations of the
biomechanics structure, but typical abnormal changes
in the neuromuscular control, are responsible for the
disease. In this context, the EMG patterns will contribute
essentially to the understanding of the situation, and it
may be extremely helpful for planning operations and
interventions, while it may clarify why that physiother-
apy does not improve the spasticity of the movements.
In essence, the understanding and assessment of move-
ments of the upper extremities need the transfer of pro-
cedures, knowledge and expertise gained from gait
analyses. Applications in the occupational or ergonomic
context, in sports, and in daily life situations will be
a challenge to biomechanics research while the clinical
applications may increase the complexity of the
movement as well as its di$culties of detection and
interpretation.
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