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The Trendelenburg Gait A Personalised Monitoring and Recommendation Framework for Kinetic Dysfunctions: The Trendelenburg Gait Nikolaos Michalopoulos George E. Raptis Christina Katsini Moment Kinetics Moment Kinetics Moment Kinetics nmichalopoulos@ graptis@ ckatsini@ momentkinetics.com momentkinetics.com momentkinetics.com Theofilos Chrysikos Michail Mamalakis Andrew Vigotsky ECE Department ECE Department Biomedical Engineering Dept. University of Patras University of Patras Northwestern University [email protected] [email protected] [email protected] ABSTRACT bilitative perspective, it is possible to identify the risk of Kinetics and kinematics have been the focus of a lot of re-injury on an individual basis through the application of research throughout the years, and technological advances biomechanical kinematics and kinetics. The identification have contributed towards advanced monitoring and analysing of causality often requires precise analysis, as patients fre- of motion. Focusing on Trendelenburg Gait, an abnormal quently present a plethora of compensatory movement pat- gait, a personalisation framework for monitoring and eval- terns. Such compensatory deficits and impairments are often uating the movement is proposed in this paper based on a more noticeable than the underlying cause [15], making the number of factors, such as individuals' body composition, diagnosis process even more challenging. However, quantify- motion mechanisms, capturing process, analysis tools and ing the mobility state of a medical disorder and determining information presentation techniques. A formal description the neuromuscular-skeletal contributions to that state helps of such factors allow for a better understanding and deeper in prescribing treatment and assessing the outcome with analysis of the critical points, enabling the framework to greater confidence. The most accurate systems for captur- provide improvement recommendations, applied in interdis- ing gait patterns are camera-based, which require an expen- ciplinary contexts such as rehabilitation, medical applica- sive experimental setup and a complicated calibration phase tions, strength and conditioning, and sport performance. [1, 15]. Such systems calculate and report reduced internal hip abduction moments and external knee adduction mo- ments following intramuscular hypertonic saline injections CCS Concepts [10]. However, research regarding gait analysis on the Tren- •Hardware ! Sensor devices and platforms; •Social and delenburg gait pattern is limited. Examination of this gait professional topics ! Medical technologies; pattern arises from the Trendelenburg test, in which the in- dividual is seen "standing on the treated (affected) leg and Keywords raising the buttock of the other side up to or above the hori- zontal line" [27]. Failure of the test implies being unable to Trendelenburg gait; kinetic dysfunction; personalisation and stand on this position [27]. recommendation framework; ultrasonic sensors Advances in computer technology, simulation models, and artificial intelligence have increased the potential of design- 1. INTRODUCTION ing and developing personalisation, both on-demand and in- time, mechanisms. Utilising computational techniques to The general aim of clinical movement analysis is to iden- model patients' locomotion offers a personalised experience, tify and understand mechanopathology and pathomechan- improving individuals' life quality. However, the design of ics. With the application of biomechanical analysis, injury such effective and efficient personalised platforms is an elu- causality could be identified and the kinematics associated sive task, as it is related to an interdisciplinary background, with an injury can effectively be treated, leading to improve- such as biomechanics and computer engineering, taking into ments in quality of life and performance. From a reha- account various physical, human, technological, and applica- Permission to make digital or hard copies of all or part of this work for personal or tion design factors. The interrelation and interdependences classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation among the aforementioned factors are defined by the charac- on the first page. Copyrights for components of this work owned by others than the teristics of the designed application, such as anthropometric author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or data, human locomotion kinetics and kinematics, data trans- republish, to post on servers or to redistribute to lists, requires prior specific permission mission mechanisms, and tools of data visualisation. In this and/or a fee. Request permissions from [email protected]. context, this paper contributes to the design for personalised PCI ’16, November 10 - 12, 2016, Patras, Greece experience by proposing a factor-based framework that can c 2016 Copyright held by the owner/author(s). Publication rights licensed to ACM. ISBN 978-1-4503-4789-1/16/11. $15.00 be used to monitor, evaluate, and recommend improvements DOI: http://dx.doi.org/10.1145/3003733.3003786 on the treatment process of Trendelenburg gait. 2. RELATED WORK 4. DATA MINING Trendelenburg Gait has not received a lot of interdisci- Several tracking systems have been used to capture the plinary attention. To the authors' knowledge, only two critical points of the Trendelenburg gait pattern; however, teams [1, 10] have formerly researched this abnormal gait they are mainly based on sport performance, tracking exer- pattern either implicitly or explicitly. Existing monitoring cises like barbell squats. Taking into consideration that sim- systems [12, 18] are not specified for Trendelenburg gait ilar kinetics are used for Trendelenburg gait pattern, funda- analysis, but they could be applied in this domain. How- mental mechanisms of the proposed tracking systems could ever, these systems model the human body based on the be applied to our case study. Research reports that camera- average human metrics, thus disregarding the characteris- based tracking systems are the most accurate, nonetheless tics of each particular person. Nonetheless, personalisation, the sensitivity of such systems in terms of lighting, shadow recommendation and adaptation have received a lot of re- and clutter question the system effectiveness [3]. Attempts search in other contexts than kinetic dysfunction domain, to use microelectromechanical systems and inertial sensors with promising results in terms of enhanced user experi- have also been made, but they have proven to be prone to ences and enriched provided services [8, 24]. Given that, error due to sensor bias and measurement noise [12, 18]. In in the context of medical applications and kinetic dysfunc- the present paper, we propose an alternative method which tion, patients' locomotion and kinetics have a great impact makes use of the ultrasound technique. on the treatment process, a personalised monitoring and rec- ommending system could add value to the existing capturing 4.1 Ultrasonic sensors for positioning systems and boost the supported procedures. This requires measurement in depth understanding of the patients' locomotion and ki- Advances in the research and experimental study of sen- netics combined with exploitation of existing wireless wear- sors have allowed for various protocols functioning in the able tracking systems and high-level system adaptation. infrared-radio ultra wide band (IR-UWB) channel [14, 21]. Methods due to innovative techniques in microelectrome- chanical system technology such as accelerometer and gyro- 3. TRENDELENBURG GAIT scope have been investigated in [12, 13, 18]. Human tracking The Trendelenburg gait pattern, named after German sur- is feasible both in tri-axial and dual-axial reference systems geon Dr Friedrich Tredelenburg, is an abnormal gait caused and user movement phenomena have been mitigated with by weakness of the abductor muscles of the lower limb, glu- the application of the Kalman filter [17]. The transmis- teus medius and gluteus minimus [25]. When a person walks sion of the acquired empirical data is robust and accurate, with such an abnormal gait, the hip joint is subjected to however the increased complexity and cost of implemen- stresses in areas not normally stressed during gait. This re- tation and maintenance renders this method inappropriate sults in the development of other pathologies of the bones for on-the-fly solutions regarding positioning measurements. and cartilage in the hip and knee, such as arthritis or prema- In addition, path loss and multipath propagation phenom- ture wear in the cartilage hip joints [26, 28]. Trendelenburg ena need to be accounted for. Our application, designed gait is also associated with the development of pathology for sporting areas and gymnastic halls, as well as medical at the knee or ankles over a period of years [25], e.g. val- centers and treatment rooms, requires the investigation of gus of the knee is caused by the laterally displaced weight distance-dependent free space attenuation as well as large- over the hip [15]. It is characterized by a trunk shift over scale (shadow) fading which contribute to the overall losses the affected hip, due to weakness of the hip abductors, and of the signal strength and the stochastic variations around is best visualized from behind or in front of the patient. its local mean [5]. Observation of the patients' gait from the
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