Ambulatory measurement of ankle kinetics for clinical applications.

This study aimed to design and validate the measurement of ankle kinetics (force, moment, and power) during consecutive gait cycles and in the field using an ambulatory system. An ambulatory system consisting of plantar pressure insole and inertial sensors (3D gyroscopes and 3D accelerometers) on foot and shank was used. To test this system, 12 patients and 10 healthy elderly subjects wore shoes embedding this system and walked many times across a gait lab including a force-plate surrounded by seven cameras considered as the reference system. Then, the participants walked two 50-meter trials where only the ambulatory system was used. Ankle force components and sagittal moment of ankle measured by ambulatory system showed correlation coefficient (R) and normalized RMS error (NRMSE) of more than 0.94 and less than 13% in comparison with the references system for both patients and healthy subjects. Transverse moment of ankle and ankle power showed R>0.85 and NRMSE<23%. These parameters also showed high repeatability (CMC>0.7). In contrast, the ankle coronal moment of ankle demonstrated high error and lower repeatability. Except for ankle coronal moment, the kinetic features obtained by the ambulatory system could distinguish the patients with ankle osteoarthritis from healthy subjects when measured in 50-meter trials. The proposed ambulatory system can be easily accessible in most clinics and could assess main ankle kinetics quantities with acceptable error and repeatability for clinical evaluations. This system is therefore suggested for field measurement in clinical applications.

[1]  F C T van der Helm,et al.  Inverse dynamics calculations during gait with restricted ground reaction force information from pressure insoles. , 2006, Gait & posture.

[2]  Peter H. Veltink,et al.  Ambulatory Assessment of Ankle and Foot Dynamics , 2007, IEEE Transactions on Biomedical Engineering.

[3]  A Leardini,et al.  Position and orientation in space of bones during movement: anatomical frame definition and determination. , 1995, Clinical biomechanics.

[4]  Raziel Riemer,et al.  Improving joint torque calculations: optimization-based inverse dynamics to reduce the effect of motion errors. , 2008, Journal of biomechanics.

[5]  Thurmon E Lockhart,et al.  Comparison of 3D joint moments using local and global inverse dynamics approaches among three different age groups. , 2006, Gait & posture.

[6]  H Labelle,et al.  Functional roles of ankle and hip sagittal muscle moments in able-bodied gait. , 2001, Clinical biomechanics.

[7]  Catherine Dehollain,et al.  Gait assessment in Parkinson's disease: toward an ambulatory system for long-term monitoring , 2004, IEEE Transactions on Biomedical Engineering.

[8]  Kuan Zhang,et al.  Assessment of human locomotion by using an insole measurement system and artificial neural networks. , 2005, Journal of biomechanics.

[9]  B M Jolles,et al.  Evaluation of a mixed approach combining stationary and wearable systems to monitor gait over long distance. , 2010, Journal of biomechanics.

[10]  Edwin van Asseldonk,et al.  Ambulatory Estimation of Center of Mass Displacement During Walking , 2009, IEEE Transactions on Biomedical Engineering.

[11]  H J Stam,et al.  Validity of the Pedar Mobile system for vertical force measurement during a seven-hour period. , 2006, Journal of biomechanics.

[12]  Sebastian I. Wolf,et al.  Spatial synchronization of an insole pressure distribution system with a 3D motion analysis system for center of pressure measurements , 2008, Medical & Biological Engineering & Computing.

[13]  K. Aminian,et al.  Segmentation of foot and ankle complex based on kinematic criteria , 2011, Computer methods in biomechanics and biomedical engineering.

[14]  M. Pepper,et al.  Design, development, and characteristics of an in-shoe triaxial pressure measurement transducer utilizing a single element of piezoelectric copolymer film , 2003, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[15]  M. Kljajić,et al.  The use of ground reaction measuring shoes in gait evaluation. , 1987, Clinical physics and physiological measurement : an official journal of the Hospital Physicists' Association, Deutsche Gesellschaft fur Medizinische Physik and the European Federation of Organisations for Medical Physics.

[16]  P. Devita,et al.  Errors in alignment of center of pressure and foot coordinates affect predicted lower extremity torques. , 1995, Journal of biomechanics.

[17]  E. Berton,et al.  Influence of body segments' parameters estimation models on inverse dynamics solutions during gait. , 2006, Journal of biomechanics.

[18]  K. Aminian,et al.  Quaternion-based fusion of gyroscopes and accelerometers to improve 3D angle measurement , 2006 .

[19]  Anthony G Schache,et al.  On the expression of joint moments during gait. , 2007, Gait & posture.

[20]  B. MacWilliams,et al.  Foot kinematics and kinetics during adolescent gait. , 2003, Gait & posture.

[21]  H. Stam,et al.  A model for the relation between the displacement of the ankle and the center of pressure in the frontal plane, during one-leg stance , 1997 .

[22]  M. Tomizuka,et al.  A mobile gait monitoring system for abnormal gait diagnosis and rehabilitation: a pilot study for Parkinson disease patients. , 2011, Journal of biomechanical engineering.

[23]  K Aminian,et al.  Ambulatory assessment of 3D ground reaction force using plantar pressure distribution. , 2010, Gait & posture.

[24]  K. Aminian,et al.  Ambulatory measurement of 3D knee joint angle. , 2008, Journal of biomechanics.

[25]  G A Spolek,et al.  An instrumented shoe-a portable force measuring device. , 1976, Journal of biomechanics.

[26]  A. Leardini,et al.  Data management in gait analysis for clinical applications. , 1998, Clinical biomechanics.

[27]  S. Miyazaki,et al.  Foot-force measuring device for clinical assessment of pathological gait , 1978, Medical and Biological Engineering and Computing.

[28]  A Leardini,et al.  GAIT analysis in patients operated with a novel total ankle prosthesis. , 2009, Gait & posture.

[29]  Richard Smith,et al.  Interpretation of Ankle Joint Moments during the Stance Phase of Walking: A Comparison of Two Orthogonal Axes Systems , 2001 .

[30]  K Aminian,et al.  Outcome evaluation of ankle osteoarthritis treatments: plantar pressure analysis during relatively long-distance walking. , 2011, Clinical biomechanics.

[31]  D. Howard,et al.  Whole body inverse dynamics over a complete gait cycle based only on measured kinematics. , 2008, Journal of biomechanics.

[32]  K. Aminian,et al.  Stride-to-stride variability while enumerating animal names among healthy young adults: result of stride velocity or effect of attention-demanding task? , 2008, Gait & posture.

[33]  P. Veltink,et al.  Ambulatory measurement of ground reaction forces , 2005 .

[34]  Vinzenz von Tscharner,et al.  Gait analysis in ankle osteoarthritis and total ankle replacement. , 2007, Clinical biomechanics.

[35]  A. Faivre,et al.  Instrumented shoes for pathological gait assessment , 2004 .

[36]  P. Veltink,et al.  Evaluation of instrumented shoes for ambulatory assessment of ground reaction forces. , 2007, Gait & posture.

[37]  M Lord,et al.  A study of in-shoe plantar shear in normals. , 2000, Clinical biomechanics.

[38]  Anthony G Schache,et al.  Differences in lower limb transverse plane joint moments during gait when expressed in two alternative reference frames. , 2007, Journal of biomechanics.

[39]  Kamiar Aminian,et al.  Improved Physical Activity in Patients Treated for Chronic Pain by Spinal Cord Stimulation , 2005, Neuromodulation : journal of the International Neuromodulation Society.

[40]  A Leardini,et al.  An anatomically based protocol for the description of foot segment kinematics during gait. , 1999, Clinical biomechanics.