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Advancing Clinical Gait Analysis Through Technology and Policy

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Advancing Clinical Gait Analysis Through Technology and Policy Advancing Clinical Gait Analysis Through Technology and Policy by Junjay Tan B.S., Mechanical Engineering and B.A., Plan II Liberal Arts The University of Texas at Austin, 2006 Submitted to the Engineering Systems Division and the Department of Mechanical Engineering in Partial Fulfillment of the Requirements for the Degrees of MASTER OF SCIENCE IN TECHNOLOGY AND POLICY and MASTER OF SCIENCE IN MECHANICAL ENGINEERING at the MASSACHUSETTS INSTITUTE OF TECHNOLOGY June 2009 2009 Massachusetts Institute of Technology. All rights reserved. Signature of Author: Engineering Systems Division and Dept. of Mechanical Engineering April 20, 2009 Certified by: Dava J. Newman Professor of Aeronautics and Astronautics and Engineering Systems Thesis Supervisor Certified by: C. Forbes Dewey, Jr. Professor of Mechanical Engineering and Biological Engineering Thesis Reader Accepted by: Dava J. Newman Professor of Aeronautics and Astronautics and Engineering Systems Director, Technology and Policy Program Accepted by: David E. Hardt Chairman, Committee on Graduate Students Department of Mechanical Engineering Advancing Clinical Gait Analysis Through Technology and Policy by Junjay Tan Submitted to the Engineering Systems Division and the Department of Mechanical Engineering on April 20, 2009 in Partial Fulfillment of the Requirements for the Degree of Master of Science in Technology and Policy and the Degree of Master of Science in Mechanical Engineering. Abstract Quantitatively analyzing human gait biomechanics will improve our ability to diagnose and treat disability and to measure the effectiveness of assistive devices. Gait analysis is one technology used to analyze walking, but technical as well as economic, social, and policy issues hinder its clinical adoption. This thesis is divided into two parts that address some of these issues. Part I focuses on the role public policies have in advancing gait analysis. Through an analysis of gait analysis technologies, case studies of MRI and CT Angiography, and a high-level analysis of data standards used in gait analysis, it concludes that policies cannot directly create the institutional structures and the data standards required to advance gait analysis as a clinical diagnostic tool. Only through indirect means, such as research funding, can policies support the development of organizations to take ownership of gait analysis technologies. Part I also concludes that policies should not fund development of gait technologies but instead should fund research units working on data standards and accurate human body models. Part II focuses on a technical issue in gait analysis, namely, how to address uncertainties in joint moment calculations that occur from using different body segment inertial parameter estimation models. This is identified as a technical issue needing attention from our broader policy analysis in Part I. Using sensitivity studies of forward dynamics computer simulations coupled with an analysis of the dynamical equations of motion, Part II shows that joint moment variations resulting from different segment inertial parameters are significant at some parts of the gait cycle, particularly heel strike and leg swing. It provides recommendations about which segment inertial parameters one should estimate more accurately depending on which joints and phases of the gait cycle one is interested in analyzing. Thesis Supervisor: Dava J. Newman, Professor of Aeronautics and Astronautics and Engineering Systems Thesis Reader: C. Forbes Dewey, Jr., Professor of Mechanical Engineering and Biological Engineering Acknowledgements “Oh I get by with a little help from my friends/ I get high with a little help from my friends/ Oh I'm gonna try with a little help from my friends/” --The Beatles First and foremost, thanks to my parents and my sister Lilian for their love, support, and confidence in my abilities through the years. I would not be where I am today without them. Thanks to Dava for her creative spirit, generosity, support, and broad perspective on life. She has taught me much throughout my years at MIT. Thanks also to Forbes for his insights and advice in graduate school, as well as for introducing me to many aspects of bioengineering and biomedical informatics I had not known about before coming to MIT. A big thanks to all my good friends at MIT who have kept me smiling through hard times, provided heart-to-heart talks, and reminded me of the beauty of life when things were down, especially Kyle (Mr. “Buddy Lee”), Tim, Rob (“Dr. Love”), Megan, Valerie, Shan, Decker, Monica, Zoe, Romain Levy, Travis, and Jesse. Also, thanks to other members of the MIT community who have taken time to mentor me in various ways, including Gari Clifford and Ken Zolot. Thanks to all the other student, faculty, and staff members of the Man-Vehicle Lab who have made my graduate experience enjoyable—especially Thaddeus, Jessicas (both of them), Jaime, Chris, and Zakiya. I especially thank my officemate Roedolph for making our office the most fun office in the world, even if we didn’t have sunlight and had to battle roaches at times. Good thing we had our Nerf gun! A special “thanks, mate” to James Waldie for his help and moral support. The lab could not ask for a better (and more fun) postdoc. Thanks also to Alan Natapoff for ideas and help with statistical analysis. Thanks to Sydney, Ed, and Sally for helping me with various administrative issues that have arisen (as well as great conversations). I gratefully acknowledge the MIT-Portugal Program for funding much of this research. Thanks to Frank Field for his funding through a TA position in ESD.10, and to Profs. Pierre Lermusiaux, Evelyn Wang, and Alexander Mitsos for their funding through a TA position in 2.005, as well as Martin Segado, who was a great 2.005 co-TA. It was a great joy to work with you all! Table of Contents Abstract ......................................................................................................................................3 Acknowledgements.....................................................................................................................5 Table of Contents........................................................................................................................7 List of Figures...........................................................................................................................11 List of Tables ............................................................................................................................13 1 Introduction.......................................................................................................................15 1.1 Problem.....................................................................................................................15 1.1.1 Health Technology Policy..................................................................................15 1.1.2 Gait Analysis Technical Issue ............................................................................16 1.2 Research Overview....................................................................................................16 1.2.1 Research Questions............................................................................................16 1.2.2 Hypotheses ........................................................................................................16 1.2.3 Methodology......................................................................................................17 1.2.4 Conclusions .......................................................................................................17 1.2.5 Contributions.....................................................................................................17 1.2.6 Limitations and Future Work .............................................................................17 1.3 Motivation.................................................................................................................18 1.4 Definitions.............................................................................................................19 1.5 Overview of the Following Chapters......................................................................20 PART I: Public Policies for Advancing Gait Analysis...........................................................21 Hypothesis ............................................................................................................................21 Scope ....................................................................................................................................21 Methodology.........................................................................................................................22 Overview of Proceeding Chapters in Part I............................................................................22 2 Gait Analysis and Related Policies ....................................................................................23 2.1 Health Technology Policy..........................................................................................23 2.1.1 Rationale for Government Intervention ..............................................................23 2.1.2 Regulation of Diagnostic Technologies ..............................................................23 2.1.3 Reimbursement..................................................................................................24 2.1.4 Evidence-based medicine...................................................................................25
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