Robust deep learning-based gait event detection across various pathologies.

The correct estimation of gait events is essential for the interpretation and calculation of 3D gait analysis (3DGA) data. Depending on the severity of the underlying pathology and the availability of force plates, gait events can be set either manually by trained clinicians or detected by automated event detection algorithms. The downside of manually estimated events is the tedious and time-intensive work which leads to subjective assessments. For automated event detection algorithms, the drawback is, that there is no standardized method available. Algorithms show varying robustness and accuracy on different pathologies and are often dependent on setup or pathology-specific thresholds. In this paper, we aim at closing this gap by introducing a novel deep learning-based gait event detection algorithm called IntellEvent, which shows to be accurate and robust across multiple pathologies. For this study, we utilized a retrospective clinical 3DGA dataset of 1211 patients with four different pathologies (malrotation deformities of the lower limbs, club foot, infantile cerebral palsy (ICP), and ICP with only drop foot characteristics) and 61 healthy controls. We propose a recurrent neural network architecture based on long-short term memory (LSTM) and trained it with 3D position and velocity information to predict initial contact (IC) and foot off (FO) events. We compared IntellEvent to a state-of-the-art heuristic approach and a machine learning method called DeepEvent. IntellEvent outperforms both methods and detects IC events on average within 5.4 ms and FO events within 11.3 ms with a detection rate of ≥ 99% and ≥ 95%, respectively. Our investigation on generalizability across laboratories suggests that models trained on data from a different laboratory need to be applied with care due to setup variations or differences in capturing frequencies.

Identification of subject-specific responses to footwear during running.

Placing a stronger focus on subject-specific responses to footwear may lead to a better functional understanding of footwear's effect on running and its influence on comfort perception, performance, and pathogenesis of injuries. We investigated subject-specific responses to different footwear conditions within ground reaction force (GRF) data during running using a machine learning-based approach. We conducted our investigation in three steps, guided by the following hypotheses: (I) For each subject x footwear combination, unique GRF patterns can be identified. (II) For each subject, unique GRF characteristics can be identified across footwear conditions. (III) For each footwear condition, unique GRF characteristics can be identified across subjects. Thirty male subjects ran ten times at their preferred (self-selected) speed on a level and approximately 15 m long runway in four footwear conditions (barefoot and three standardised running shoes). We recorded three-dimensional GRFs for one right-foot stance phase per running trial and classified the GRFs using support vector machines. The highest median prediction accuracy of 96.2% was found for the subject x footwear classification (hypothesis I). Across footwear conditions, subjects could be discriminated with a median prediction accuracy of 80.0%. Across subjects, footwear conditions could be discriminated with a median prediction accuracy of 87.8%. Our results suggest that, during running, responses to footwear are unique to each subject and footwear design. As a result, considering subject-specific responses can contribute to a more differentiated functional understanding of footwear effects. Incorporating holistic analyses of biomechanical data is auspicious for the evaluation of (subject-specific) footwear effects, as unique interactions between subjects and footwear manifest in versatile ways. The applied machine learning methods have demonstrated their great potential to fathom subject-specific responses when evaluating and recommending footwear.

Modeling biological individuality using machine learning: A study on human gait.

Human gait is a complex and unique biological process that can offer valuable insights into an individual's health and well-being. In this work, we leverage a machine learning-based approach to model individual gait signatures and identify factors contributing to inter-individual variability in gait patterns. We provide a comprehensive analysis of gait individuality by (1) demonstrating the uniqueness of gait signatures in a large-scale dataset and (2) highlighting the gait characteristics that are most distinctive to each individual. We utilized the data from three publicly available datasets comprising 5368 bilateral ground reaction force recordings during level overground walking from 671 distinct healthy individuals. Our results show that individuals can be identified with a prediction accuracy of 99.3% by using the bilateral signals of all three ground reaction force components, with only 10 out of 1342 recordings in our test data being misclassified. This indicates that the combination of bilateral ground reaction force signals with all three components provides a more comprehensive and accurate representation of an individual's gait signature. The highest accuracy was achieved by (linear) Support Vector Machines (99.3%), followed by Random Forests (98.7%), Convolutional Neural Networks (95.8%), and Decision Trees (82.8%). The proposed approach provides a powerful tool to better understand biological individuality and has potential applications in personalized healthcare, clinical diagnosis, and therapeutic interventions.

Gutenberg Gait Database, a ground reaction force database of level overground walking in healthy individuals.

The Gutenberg Gait Database comprises data of 350 healthy individuals recorded in our laboratory over the past seven years. The database contains ground reaction force (GRF) and center of pressure (COP) data of two consecutive steps measured - by two force plates embedded in the ground - during level overground walking at self-selected walking speed. The database includes participants of varying ages, from 11 to 64 years. For each participant, up to eight gait analysis sessions were recorded, with each session comprising at least eight gait trials. The database provides unprocessed (raw) and processed (ready-to-use) data, including three-dimensional GRF and two-dimensional COP signals during the stance phase. These data records offer new possibilities for future studies on human gait, e.g., the application as a reference set for the analysis of pathological gait patterns, or for automatic classification using machine learning. In the future, the database will be expanded continuously to obtain an even larger and well-balanced database with respect to age, sex, and other gait-specific factors.

GaiTRec, a large-scale ground reaction force dataset of healthy and impaired gait.

The quantification of ground reaction forces (GRF) is a standard tool for clinicians to quantify and analyze human locomotion. Such recordings produce a vast amount of complex data and variables which are difficult to comprehend. This makes data interpretation challenging. Machine learning approaches seem to be promising tools to support clinicians in identifying and categorizing specific gait patterns. However, the quality of such approaches strongly depends on the amount of available annotated data to train the underlying models. Therefore, we present GAITREC, a comprehensive and completely annotated large-scale dataset containing bi-lateral GRF walking trials of 2,084 patients with various musculoskeletal impairments and data from 211 healthy controls. The dataset comprises data of patients after joint replacement, fractures, ligament ruptures, and related disorders at the hip, knee, ankle or calcaneus during their entire stay(s) at a rehabilitation center. The data sum up to a total of 75,732 bi-lateral walking trials and enable researchers to classify gait patterns at a large-scale as well as to analyze the entire recovery process of patients.

Input representations and classification strategies for automated human gait analysis.

BACKGROUND: Quantitative gait analysis produces a vast amount of data, which can be difficult to analyze. Automated gait classification based on machine learning techniques bear the potential to support clinicians in comprehending these complex data. Even though these techniques are already frequently used in the scientific community, there is no clear consensus on how the data need to be preprocessed and arranged to assure optimal classification accuracy outcomes. RESEARCH QUESTION: Is there an optimal data aggregation and preprocessing workflow to optimize classification accuracy outcomes? METHODS: Based on our previous work on automated classification of ground reaction force (GRF) data, a sequential setup was followed: firstly, several aggregation methods - early fusion and late fusion - were compared, and secondly, based on the best aggregation method identified, the expressiveness of different combinations of signal representations was investigated. The employed dataset included data from 910 subjects, with four gait disorder classes and one healthy control group. The machine learning pipeline comprised principle component analysis (PCA), z-standardization and a support vector machine (SVM). RESULTS: The late fusion aggregation, i.e., utilizing majority voting on the classifier's predictions, performed best. In addition, the use of derived signal representations (relative changes and signal differences) seems to be advantageous as well. SIGNIFICANCE: Our results indicate that great caution is needed when data preprocessing and aggregation methods are selected, as these can have an impact on classification accuracies. These results shall serve future studies as a guideline for the choice of data aggregation and preprocessing techniques to be employed.

KAVAGait: Knowledge-Assisted Visual Analytics for Clinical Gait Analysis.

In 2014, more than 10 million people in the US were affected by an ambulatory disability. Thus, gait rehabilitation is a crucial part of health care systems. The quantification of human locomotion enables clinicians to describe and analyze a patient's gait performance in detail and allows them to base clinical decisions on objective data. These assessments generate a vast amount of complex data which need to be interpreted in a short time period. We conducted a design study in cooperation with gait analysis experts to develop a novel Knowledge-Assisted Visual Analytics solution for clinical Gait analysis (KAVAGait). KAVAGait allows the clinician to store and inspect complex data derived during clinical gait analysis. The system incorporates innovative and interactive visual interface concepts, which were developed based on the needs of clinicians. Additionally, an explicit knowledge store (EKS) allows externalization and storage of implicit knowledge from clinicians. It makes this information available for others, supporting the process of data inspection and clinical decision making. We validated our system by conducting expert reviews, a user study, and a case study. Results suggest that KAVAGait is able to support a clinician during clinical practice by visualizing complex gait data and providing knowledge of other clinicians.

Automatic Classification of Functional Gait Disorders.

This paper proposes a comprehensive investigation of the automatic classification of functional gait disorders (GDs) based solely on ground reaction force (GRF) measurements. The aim of this study is twofold: first, to investigate the suitability of the state-of-the-art GRF parameterization techniques (representations) for the discrimination of functional GDs; and second, to provide a first performance baseline for the automated classification of functional GDs for a large-scale dataset. The utilized database comprises GRF measurements from 279 patients with GDs and data from 161 healthy controls (N). Patients were manually classified into four classes with different functional impairments associated with the "hip", "knee", "ankle", and "calcaneus". Different parameterizations are investigated: GRF parameters, global principal component analysis (PCA) based representations, and a combined representation applying PCA on GRF parameters. The discriminative power of each parameterization for different classes is investigated by linear discriminant analysis. Based on this analysis, two classification experiments are pursued: distinction between healthy and impaired gait (N versus GD) and multiclass classification between healthy gait and all four GD classes. Experiments show promising results and reveal among others that several factors, such as imbalanced class cardinalities and varying numbers of measurement sessions per patient, have a strong impact on the classification accuracy and therefore need to be taken into account. The results represent a promising first step toward the automated classification of GDs and a first performance baseline for future developments in this direction.