Clinical Gait Analysis I - Kinematic Data Analysis

Kwabena Kan–Dapaah, Ph.D.

December 19, 2023

Outline

1 Introduction
Definitions
Kinematic Data Analysis
Segment and Joint Angles

2 Pelvic Anatomical Coordinate System (PACS)

3 Thigh Anatomical Coordinate System (TACS)

TACS
 Introduction
Pelvic Anatomical Coordinate System (PACS)
Thigh Anatomical Coordinate System (TACS)

Details

At the end of this lecture, you should:

know the area of clinical gait analysis
know how to use the Clinical Gait Model and its use for
clinical gait analysis
explain how analysis results are used to quantify pathological
condition, to suggest surgical and clinical treatment, and to
quantify their effectiveness

References:
Intro. to Biomed. Eng., 2nd Ed., Enderle et al. - Chapter 4.6
Intro. to Biomech.: From Cells to Organisms, C.R. Ethier and C. A.
Simmons - Chapter 10.3

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Clinical Gait Analysis I

Definition
It involves measurements, analysis & interpretation,
recommendation

A collaborative process involves:

a physician
a physical therapist or kinesiologist
an engineer or technician:
set up measurement devices
develop protocols and models

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Clinical Gait Analysis II

Measurements
Main data: instantaneous location of limbs
video-based motion cameras with reflective markers placed on
surface of the subject
Inertial Measurement Units
Others:
Kinematics: goniometers, accelerometers
Kinetics: force plates
Electromyography: surface or internal electrodes
Anthropometry: weight balance, tapes, stadiometer

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Clinical Gait Analysis III

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Clinical Gait Analysis IV

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Clinical Gait Analysis V

Analysis & Interpretation

develop model such as clinical gait model, link segment model
compare results with averages
Recommendation
Diagnostic tools: musculoskeletal and/or neurological control
problems

Evaluation of treatment: surgery, drugs, assisted device

Long term clinical monitoring of surgical patients: e.g.

patients who have received total artificial knees

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

The Clinical Gait Model (CGM)

Definition
It is an algorithm that transform the data collected during walking
trials into the information required for clinical interpretation
Design depends on specific aspects of its dynamics of interest
Limitations: measurement system and appropriate protocols

An acceptable CGM must be:

useful for different patients
sophisticated to answer biomechanical questions
based on repeatable protocols and feasible in clinical setting

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Description of Procedure I

Background
Reflective markers placed on skin surface
monitored by system of video-based cameras
space
time
trajectories used to compute anatomical coordinate system
(ACS)
ACS - used as basis for
absolute spatial orientation or relative angular displacement of
body segment
angular displacement of one segment relative to another

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Description of Procedure II
Key Requirements for Markers
Minimum of 3
Form plane to derive segmentally fixed
coordinate system
Analysis Dimensions:
2D or
3D (challenging)
Placement on segment:
palpable bony landmarks
at convenient locations
referenced to underlying bone

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Euler Angles I

xyz is rotated about the y axis (top), transforming the ijk unit
vectors into the i 0 j 0 k 0 unit vectors, via the equations

i 0 = cos θy i − sin θy k
j0 = j
k 0 = sin θy i + cos θy k

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Euler Angles II

This new primed coordinate system is then rotated about the x

axis (Fig. 4.6, middle), giving the double-primed system:

i 00 = i 0
j 00 = cos θx j 0 + sin θx k 0
k 00 = − sin θx j 0 + cos θx k 0

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Euler Angles III

Finally, the double-primed system is rotated about the z axis,

giving the triple-primed system:

i 000 = cos θz i 00 + sin θz j 00

j 000 = − sin θz i 00 + cos θz j 00
k 000 = k 00

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction Definitions
Pelvic Anatomical Coordinate System (PACS) Kinematic Data Analysis
Thigh Anatomical Coordinate System (TACS) Segment and Joint Angles

Euler Angles IV

θx = − arcsin(k 000 · j)
k ·i
 000 
θy = arcsin
cos θx
i ·j
 000 
θz = arcsin
cos θx

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS)
Thigh Anatomical Coordinate System (TACS)

Marker locations

1 Right anterior-superior-iliac-spine (RASIS)

2 Left anterior-superior-iliac-spine (LASIS)
3 Right or Left posterior-superior-iliac-spine (PSIS)

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS)
Thigh Anatomical Coordinate System (TACS)

Marker locations

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS)
Thigh Anatomical Coordinate System (TACS)

3D Analysis
Question
Given the ff. 3D locations of pelvic markers expressed relative to
an inertially fixed laboratory coordinate system.

RASIS = −0.850i − 0.802j + 0.652k

LASIS = −0.831i − 0.651j + 0.652k
PSIS = −1.015i − 0.704j + 0.686k

Compute an anatomical coordinate system for the pelvis.

Soln : 3 markers form a plane, coordinate system axes formed by

1 y-axis: line between RASIS & LASIS
2 z-axis: perpendicular to the pelvic plane
3 x-axis: orthogonal to y & z axes

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS)
Thigh Anatomical Coordinate System (TACS)

3D Analysis
1. Subtract vector RASIS from vector LASIS

r1 = (−0831 − (−0.850))i + (−0.651 − (−0.802))j + (0.652 − 0.652)k

r1 = 0.019i + 0.151j + 0.000k

It’s associated unit vector is:

er1 = 0.125i + 0.992j + 0.000k

er1 −the medial-lateral direction or y-axis for the PACS, epay

2. A second vector, r2 , in the pelvic plane required to compute
coordinate axis perpendicular to the plane: r2 = PSIS − RASIS

r2 = −0.165i + 0.098j + 0.034k

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS)
Thigh Anatomical Coordinate System (TACS)

3D Analysis

Take vector product of epay × r2

i j k
r3 = 0.125 0.992 0.000
−0.165 0.098 0.034
= 0.034i − 0.004j + 0.176k

and its associated unit vector:

er3 = epaz = 0.188i − 0.024j + 0.982k

er3 represents the anterior-superior direction or z axis of the PACS,

epaz

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS)
Thigh Anatomical Coordinate System (TACS)

3D Analysis
3. Take vector cross product epay × epaz

epax = 0.974i − 0.123j − 0.190k

Note: coefficients represent the direction cosines , defines

orientation of PACS relative to lab. coordinate system
Using Euler angles, absolute angular displacement of PACS can be
computed as pelvic tilt, obliquity and rotation using

θx = − arcsin(epaz · j) = 1◦
epaz · i
 
θy = arcsin = 11◦
cos θx
epax · j
 
θz = arcsin = −7◦
cos θx
θx −p. obliquity, θy −ant. p. tilt, θz −p. rotation
Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG
 Introduction
Pelvic Anatomical Coordinate System (PACS) TACS
Thigh Anatomical Coordinate System (TACS)

Background

Challenging than pelvis, since 3 bony anatomical landmarks

are not readily available as reference
A model based on markers placed over the medial (MK) and
lateral (LK) femoral condyles and the greater trochanter (H)
is appealing but plagued with difficulties
MK is not always feasible, e.g. patients whose knees make
contact
H moves significantly relative to greater trochanter
General approach, place additional markers for static
calibration
Then, find a relationship between them and the motion
markers (remain during data collection)

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS) TACS
Thigh Anatomical Coordinate System (TACS)

3D Analysis

Question
Given the ff. static marker coordinate data, compute an
anatomical coordinate system for the thigh.
LK = −0.881i − 0.858j + 0.325k
MK = −0.855i − 0.767j + 0.318k

Solution:
1 A thigh plane is formed based on

the hip centre, LK, MK

2 Knee centre, K = (LK + MK)/2
3 With these points,
1 Vector HK represents one axis
2 Another axis is perpendicular to the thigh plane
3 A third coordinate axis: orthogonal to the first two

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS) TACS
Thigh Anatomical Coordinate System (TACS)

3D Analysis
K = −0.868i − 0.812j + 0.321k,
From anthropometry and statistical model of pelvic geom.,
H = −0.906i − 0.763j + 0.593k
1. Subtract K from H

etaz = −0.137i + 0.175j + 0.975k

As with pelvis, a 2nd vector is need to calculate (2.):

r5 = MK − LK = 0.026i − 0.091j + 0.007k
2. Form cross product, r5 × etaz , and calculate unit vector

etax = 0.949i − 0.285j + 0.180k

3. etaz × etax

etay = 0.284i + 0.950j − 0.131k

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS) TACS
Thigh Anatomical Coordinate System (TACS)

3D Analysis

From previous analysis, MK is removed before trials. Thus K ,

cannot be computed as before. This dilemma is resolved by placing
another marker on the thigh such that it forms a plane

TW = −0.890i − 0.937j + 0.478k

1. r7 = LK − H = −0.025i − 0.094j + 0.268k

associated unit vector is

er7 = ettz = −0.088i + 0.0330j + 0.940k

2. Subtract LK from TW, r8 and do r7 × r8

er9 = ettx = 0.996i + 0.040j + 0.079k

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS) TACS
Thigh Anatomical Coordinate System (TACS)

3D Analysis

3. ettz × ettx

etty = −0.012i + 0.943j + 0.333k

This thigh technical coordinate system can be related to the TACS

using euler angles.
Furthermore, the position of TACS relative to PACS can be
calculated as follows:
θx − hip abduction-adduction,
θy −hip flexion-ext
θz −hip int-ext rotation

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS) TACS
Thigh Anatomical Coordinate System (TACS)

TACS

ettx 0.996 0.040 0.079 i

    

ett = etty  = −0.012 0.943 0.333  j 

ettz 0.088 0.330 0.940 k

Using Euler angles:

θx = − arcsin(etaz · epay ) = −9◦

etaz · epax
 
θy = arcsin = 20◦
cos θx
etax · epay
 
θz = arcsin = −8◦
cos θx

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG

 Introduction
Pelvic Anatomical Coordinate System (PACS) TACS
Thigh Anatomical Coordinate System (TACS)

Thank You!

Kwabena Kan–Dapaah, Ph.D. Biomechanics, UG