A Cluster-based Model Using Functional Methods Requires Less Operator Experience for Reliable Gait Analysis: A Preliminary Study of Intra- and Inter-assessor Reliability.

Reliability of three-dimensional gait analysis is important for repetitive assessments in clinical or research studies. In this paper, we hypothesized that a Strathclyde Functional Cluster Model (SFCM) in which all the joint centers and flexion axes were determined by functional methods, could improve the reliability of joint kinematics within and between operators' sessions compared to an anatomical model, Plug-in Gait (PiG). A preliminary study of intra- and inter-assessor reliability of the SFCM was been analyzed and compared to the PiG. One able-bodied participant performed eight sessions measured by four operators who have different experience level on the two models. Intra- and inter-operator reliability of the SFCM and PiG were assessed using the intraclass correlation coefficient (ICC) and standard deviation (SD). Results showed that the SFCM generated smaller SD and greater ICC values for all joint variables compared to the PiG in the inter-operator condition, suggesting that functional methods could improve the inter-operator reliability. Moreover, the intra-operator ICC results indicated that the SFCM performance was less influenced by operator experience compared to the PiG. In conclusion, as the model requires less palpation of ALs, it would benefit the users who have less experience in practical use.

A strathclyde cluster model for gait kinematic measurement using functional methods: a study of inter-assessor reliability analysis with comparison to anatomical models.

A major source of error in reliability of gait analysis arises from the palpation of anatomical landmarks (ALs). The purpose of this study was to investigate whether less reliance on manually identifying ALs could improve inter-assessor reliability of joint kinematics compared to two anatomical models. It was hypothesised that the Strathclyde functional cluster model (SFCM), in which the hip, knee and ankle joint centres and knee and ankle flexion axes were determined by functional methods, would obtain greater inter-assessor reliability. Ten able-bodied participants and seven assessors were recruited. Each participant completed three trials conducted by different assessors on non-consecutive days. Agreement and inter-assessor reliability between the models were compared and analysed, whilst factor effects of assessor experience and body mass index (BMI) were investigated. The SFCM obtained excellent agreement with anatomical models for all sagittal angles and hip ab/adduction angle, and it showed slightly higher inter-assessor reliability with smaller variations in the knee and ankle. The assessor experience was not a significant factor, but the BMI had a significant effect on the inter-assessor reliability. The results demonstrate that the SFCM may be more beneficial for less experienced assessors.

Phase 3 diagnostic evaluation of a smart tablet serious game to identify autism in 760 children 3-5 years old in Sweden and the United Kingdom.

INTRODUCTION: Recent evidence suggests an underlying movement disruption may be a core component of autism spectrum disorder (ASD) and a new, accessible early biomarker. Mobile smart technologies such as iPads contain inertial movement and touch screen sensors capable of recording subsecond movement patterns during gameplay. A previous pilot study employed machine learning analysis of motor patterns recorded from children 3-5 years old. It identified those with ASD from age-matched and gender-matched controls with 93% accuracy, presenting an attractive assessment method suitable for use in the home, clinic or classroom. METHODS AND ANALYSIS: This is a phase III prospective, diagnostic classification study designed according to the Standards for Reporting Diagnostic Accuracy Studies guidelines. Three cohorts are investigated: children typically developing (TD); children with a clinical diagnosis of ASD and children with a diagnosis of another neurodevelopmental disorder (OND) that is not ASD. The study will be completed in Glasgow, UK and Gothenburg, Sweden. The recruitment target is 760 children (280 TD, 280 ASD and 200 OND). Children play two games on the iPad then a third party data acquisition and analysis algorithm (Play.Care, Harimata) will classify the data as positively or negatively associated with ASD. The results are blind until data collection is complete, when the algorithm's classification will be compared against medical diagnosis. Furthermore, parents of participants in the ASD and OND groups will complete three questionnaires: Strengths and Difficulties Questionnaire; Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations Questionnaire and the Adaptive Behavioural Assessment System-3 or Vineland Adaptive Behavior Scales-II. The primary outcome measure is sensitivity and specificity of Play.Care to differentiate ASD children from TD children. Secondary outcomes measures include the accuracy of Play.Care to differentiate ASD children from OND children. ETHICS AND DISSEMINATION: This study was approved by the West of Scotland Research Ethics Service Committee 3 and the University of Strathclyde Ethics Committee. Results will be disseminated in peer-reviewed publications and at international scientific conferences. TRIAL REGISTRATION NUMBER: NCT03438994; Pre-results.

Treadmill training augmented with real-time visualisation feedback and function electrical stimulation for gait rehabilitation after stroke: a feasibility study.

BACKGROUND: Stroke rehabilitation often uses the motor relearning concept that require patients to perform active practice of skill-specific training and to receive feedback. Treadmill training augmented with real-time visualisation feedback and functional electrical stimulation may have a beneficial synergistic effect on motor recovery. This study aims to determine the feasibility of this kind of enhanced treadmill training for gait rehabilitation among patients after stroke. A system for dynamic visualisation of lower-limb movement based on 3-dimentional motion capture and a computer timed functional electrical stimulation system was developed. Participants received up to 20-min enhanced treadmill training instead of their over-ground gait training once or twice a week for 6 weeks at Coathill hospital, Lanarkshire, United Kingdom. Number of training sessions attended, and training duration were used to assess feasibility. Ankle kinematics in the sagittal plane of walking with and without functional electrical stimulation support of the pre-tibial muscles were also compared and used to confirm the functional electrical stimulation was triggered at the targeted time. RESULTS: Six patients after stroke participated in the study. The majority of participants were male (5/6) with a age range from 30 to 84 years and 4/6 had left hemiplegia. All participants suffered from brain infarction and were at least 3 months after stroke. Number of training sessions attended ranged from 5 to 12. The duration of training sessions ranged from 11 to 20 min. No serious adverse events were reported. The computerised functional electrical stimulation to the pre-tibial muscles was able to reduce plantarflexion angle during the swing phase with statistical significance (p = 0.015 at 80%; p = 0.008 at 90 and 100% of the gait cycle). CONCLUSIONS: It is safe and feasible to use treadmill gait training augmented with real-time visual feedback and computer-controlled functional electrical stimulation with patients after stroke in routine clinical practice. TRIAL REGISTRATION: NCT03348215. Registered 20 November 2017.

Routine clinical motion analysis: comparison of a bespoke real-time protocol to current clinical methods.

Motion analysis (MA) hardware has recently become more accessible; however, protocols have not developed in conjunction. Routine clinical assessment mostly relies on unreliable observational methods. This study aimed to develop an MA protocol for routine clinical use and compare kinematics and reliability to the gold-standard. Ten participants completed 10 over ground walks with a comprehensive marker set (bespoke and gold-standard). Inter/intra-assessor reliability was also compared. Results demonstrated comparable kinematics. Reliability of the bespoke model was lower than the gold standard but higher than observational methods. The bespoke model can be recommended for routine clinical use to assess patient progress and function.