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Gait analysis, A Comparative
             Report:
                                                  By
                                           Conor Sheehan
                                       University of Strathclyde


There are several different methods in                 commonly used, is observational analysis
examining gait and different ways in                   by a trained professional. This is where
which they are graded or assessed, from                the   examiner        will   look     for   any
standard viewing with use of a gait score              discrepancies with the person in questions
card, right up to 3D computerised                      gait, in comparison to that of a normal
instruments. Using the IMRAD report                    one, some areas that are checked include
model the following evidence and facts                 the foot position, which muscles are firing
describe, some of main methods used in                 (are active), time of stance and swing
practice for the analysis of gait:                     phase,      etc.   This   technique    is   also
                                                       sometimes combined with the use of a
The key areas that will be focused on in
                                                       digital camera system that is used for
this report include: visual gait analysis, the
                                                       recording and playback, for further study
Vicon Nexus system and the CODA system
                                                       of a subject’s gait. Also as previously
as well as the Kistler force plate which can
                                                       mentioned a score card is sometimes
be used in conjunction with any of the
                                                       used, such an example is the Edinburgh
above systems. Discussed will be how
                                                       visual gait scoring chart that helps to focus
some of the named systems work or how
                                                       in on the different areas of the gait cycle.
they   analyse    gait,   along      with   the
                                                       The main reason this is the most
advantages         and            disadvantages
                                                       frequently used practice is the fact that it
respectively. Each method will first be
                                                       is low cost and a relatively quick way of
described as an individual area before
                                                       assessing someone. There do remain
being compared against one another.
                                                       some drawbacks to this though, such as:
The first method that will be described,
which is also the simplest and most


Conor Sheehan
University of Strathclyde, 2010
In real time the human eye is not      landmarks on the subject, such an
        fast enough to pick up on some         example is the Vicon Nexus system. It
        problem areas                          works by having a number of the specially
        Observations      may       not   be   designed cameras (usually between 6 and
        quantitative or objective              12) placed round a walkway or treadmill,
        Subjects may fatigue if having to      where a patient will walk and data is
        walk for long lengths of time, this    picked up from each camera, feeding back
        could then change their walking        information to a main computer. The
        pattern                                cameras used are part of the Vicon
                                               companies T-series range which states the
The use of a camera can help in reducing
                                               cameras to be high resolution, high speed
these errors, allowing multiple viewing of
                                               and highly accurate. The cameras work by
the same person’s gait an unlimited
                                               shining an infrared (IR) beam that pick up
amount of times, the video can also be
                                               on markers that have been placed on
slowed to frame by frame steps for very
                                               anatomical landmarks of the subject, such
clear and precise viewing. However they
                                               as profound bony landmarks (iliac spines,
do bring some of their own problems, like,
                                               the malleoli of the ankle, the knee etc.)
the true angles made by the subject’s limb
                                               the IR light then reflects back off the
or the position of the ground reaction
                                               markers back into the camera. At any one
force (GRF) may not be seen as they truly
                                               time there are at least two cameras
are. The cameras must also be positioned
                                               locked on to any one marker, this is for a
correctly and images recorded from both
                                               greater information consistency, the data
the coronal and sagittal planes. Finally the
                                               is then fed back to a computer where
camera usually only remains stationary
                                               software, “Nexus” in the case in of the
and so can only capture the person
                                               Vicon Corporation, can produce a 3D
walking within a certain area of the
                                               image of the sighted object. The program
situated camera.
                                               can similarly calculate the velocity and
There are also more complex digital            acceleration of a moving limb/prosthesis
systems that use several cameras to give a     being worn; it can then display this
3-D shape of the subject and they can be       information in a variety of ways. From a
used to pick up and located positioned         2D or 3D animation that itself can be


Conor Sheehan
University of Strathclyde, 2010
moved and viewed from any angle or                  extremely    expensive    to   install   and
plane as well as being slowed or sped up.           upkeep, it needs a skilled operator and
The rest of the output information can              although fast at processing it is still more
display    information      on    body      angle   time consuming than observational gait
movements, where they peak and fall                 analysis and may not necessarily be able
throughout the different phases of gait,            to provide any extra information that
how long these peaks last for etc.                  would be of significance to the patient,
                                                    than that of a trained professionals eye
The Vicon Nexus system is probably the
                                                    could. Finally a lot more space is needed
most advanced systems for use in the
                                                    for both the hard and software to be set
study of gait, in comparison to the other
                                                    up and used.
named methods. As stated it is extremely
accurate      and    fast    at     processing      Moving on to the CODA (Cartesian
information. Furthermore, according to              Optoelectronic Dynamic Anthropometer)
Vicon, the set up and use of the software           system, which is another type of video
is easier to use than previous generation           vector system with much of the same
of the equipment, “Unlike other Gait                functions as the Vicon system. It differs in
Analysis systems, working with Vicon’s T-           a number of ways though, primarily this
Series     system    doesn’t      require     an    being, as stated by Codamotion its
engineering         degree.”(2011,          web)    producer, it is a portable device. Although
However, this may be slight bias of the             this may be the case, most clinics where it
company as this still only applies to a             is used keep it remaining in a stationary,
skilled person/technician who knows and             fixed position. Also unlike Vicon needing
understands the usage of the equipment.             several cameras positioned round the
The markers are also considered to be               walking area of the subject, the CODA
more confortable to wear for the patient,           only need one cx1 unit, which is the base
by Vicon, as the indicators are designed to         system containing the cameras. From this
be light and as they are only required to           alone it can “create 3D measurements
reflect the infrared light, not have to             without the reference of other cameras
produce it themselves like other video              units”   (Codamotion,    2011);    however
systems, described later. The systems               multiple units can be combined to give a
main disadvantage is the product is                 more accurate image. Also to compensate


Conor Sheehan
University of Strathclyde, 2010
for the lack of surrounding cameras, the        lot fewer parts that need to be assembled
sensors have a wider viewing lens,              and   positioned        with     all   the    main
approximately 80 degrees. The markers           components remaining in the single base
that are attached to the patient also           unit. While the use of the software
differ; first they are known as active          equipment       still          requires       some
markers as they produce their own light         understanding before use. According to a
source,    rather    than    reflecting   one   Dr    Barry     Meadows,               head     of
produced by the camera. Due to this             Neurobiomechanics at WESTMARK, SGH,
though the active markers need an               the CODA analytical software can be
attached power source known as a                taught to someone usually within a day.
DriveBox this does make for a more bulky        This being in contrast to the “Nexus”, that
and heavier wear for the user as well as        he said could take up to a week to learn.
the fact that wires are needed to attach
                                                Continuing on to the Kistler force plate,
the markers and DriveBox. The advantage
                                                which is a flat moving plate usually built
of this method though is the marker can
                                                into the ground of a gait lab and usually
be programed to know what landmark it is
                                                designed to match the flooring as not to
and so cannot shift or be confused by the
                                                influence the walkers gait or foot position.
camera as another anatomical region,
                                                The plate can be made in a number of
furthermore if the marker is somehow
                                                sizes and in the shape of a single slab, but
hidden from the sensor by another part of
                                                more often it is divided into two, four or
the body, the system and software can
                                                more segments. The reason for this is,
calculate to an highly accurate point the
                                                allowing a greater area to place the foot
position of where the marker is in relation
                                                and the potential ability to get the GRF on
to the other selected points.
                                                both feet without having the subject have
Much like its competitor, Vicon, the            to walk twice and hit the plate with the
output traits are much the same. It claims      opposite side. It is probably the most
the software and setup are easier to use,       important component in measuring gait.
“Working with the Codamotion System             Though independently it doesn’t serve
doesn't require an engineering degree”          much of a purpose, it can be used in
(Codamotion, 2011). This may well be true       conjunction with the above to calculate
to an extent for the setup, as there are a      the ground reaction force applied by the


Conor Sheehan
University of Strathclyde, 2010
person and position of the foot, what part      correctly stated by Dr Barry Meadows it is
of the foot is being used during initial        a quicker and less perplexing system to
contact and through stance to toe off of        learn.
that foot. With the aid of a specifically set
                                                Although both the above methods are
up camera it can also show the direction
                                                proven to be better than the conventional
and/or magnitude of where the GRF is in
                                                visual gait examination and even with the
relation to the person on the force plate,
                                                allowance of the extra time taken into
sometimes this is only done visually with
                                                consideration to use either system, it still
the length of an indicated arrow on a
                                                seems that they would be the more logical
computer screen, others it will give the
                                                practice used. This remains not the case
actual force applied as a number, or
                                                due to their high cost which currently at
sometimes both ways.
                                                the moment cannot be afforded by most
From the above finding it is clear that the     institutes and clinics, also as the more
evidence shows either the Vicon Nexus or        advanced methods take longer to run for
CODA systems with the aid of the Kistler        each patient this is seen as not an efficient
force plate are both very equally matched       use of time and so is another reason used
in use of gait analysis and have a very high    against the use of them. Finally at the
degree of accuracy if used correctly. The       moment as a skilled clinician can usually
fact the Vicon system has the greater           give just as good a result in determining
number of cameras with a wider viewing          the main problematic areas and gait
sight due to the positioning of the             deviations. So it seems unlikely that
cameras it is overall the more superior of      anything will change until there is a
the two giving a better three-dimensional       drastic diminishing in the cost of these
image. It does appear though, that the          innovative systems, the time spent to
CODA technology has a few extra added           assess a patient is reduced or there are
benefits over its counterpart, with it          extreme advances in the technology that
“technically” being mobile, only needing        makes gauging gait significantly better
the one base cx1 unit to function thus          than the eye of a professional.
resulting in less space consumption and if




Conor Sheehan
University of Strathclyde, 2010
Reference List:
        Figgins, E. 2010, Human Locomotion 6, Observing Gait, National Centre For
        Prosthetics and Orthotics
        Meadows, B. 2011, Slide 7, Gait analysis comes in many forms, WESTMARC, SGH
        Codamotion. 2010a, Advantages & Capabilities [online]. Charnwood Dynamics Ltd,
        Available at: http://www.codamotion.com/clinical-advantages-capabilities.html [6th
        March 2011].
        Codamotion. 2010b, Movement Analysis With CODA – Overview [online]. Charnwood
        Dynamics Ltd, Available at:
        http://www.codamotion.com/engineering-systems-overview.html [6th March 2011].
        Kistler. 2011a, Motion and gait analysis [online]. Kistler Holding AG, Available at:
        http://www.kistler.com/us_en-us/62_Biomechanics_Analysis/Motion-and-gait-
        analysis.html [7th March 2011].
        Kistler. 2011b, Why Kistler force plates? [online]. Kistler Holding AG, Available at:
        http://www.kistler.com/us_en-us/64_Biomechanics_Kistler/Why-Kistler-force-
        plates.html         [7th March 2011].
        Vicon. 2011a, Gait Analysis+Rehabilitation[online]. OMG plc, Available at:
        http://www.vicon.com/applications/gait_analysis.html [6th March 2011].
        Vicon. 2011b, Vicon Nexus [online]. OMG plc, Available at:
        http://www.vicon.com/products/nexus.html [5th March 2011].
        Vicon. 2011c, Vicon T-Series and T-Series S Edition[online]. OMG plc, Available at:
        http://www.vicon.com/products/tseries.html [5th March 2011].
        Wikipedia. 2011, Gait analysis [online]. Available at:
        http://en.wikipedia.org/wiki/Gait_analysis [9th March 2011].
        Wikipedia. 2011, IMRAD [online]. Available at: http://en.wikipedia.org/wiki/IMRAD
        [8th March 2011].




Conor Sheehan
University of Strathclyde, 2010

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Gait analysis report

  • 1. Gait analysis, A Comparative Report: By Conor Sheehan University of Strathclyde There are several different methods in commonly used, is observational analysis examining gait and different ways in by a trained professional. This is where which they are graded or assessed, from the examiner will look for any standard viewing with use of a gait score discrepancies with the person in questions card, right up to 3D computerised gait, in comparison to that of a normal instruments. Using the IMRAD report one, some areas that are checked include model the following evidence and facts the foot position, which muscles are firing describe, some of main methods used in (are active), time of stance and swing practice for the analysis of gait: phase, etc. This technique is also sometimes combined with the use of a The key areas that will be focused on in digital camera system that is used for this report include: visual gait analysis, the recording and playback, for further study Vicon Nexus system and the CODA system of a subject’s gait. Also as previously as well as the Kistler force plate which can mentioned a score card is sometimes be used in conjunction with any of the used, such an example is the Edinburgh above systems. Discussed will be how visual gait scoring chart that helps to focus some of the named systems work or how in on the different areas of the gait cycle. they analyse gait, along with the The main reason this is the most advantages and disadvantages frequently used practice is the fact that it respectively. Each method will first be is low cost and a relatively quick way of described as an individual area before assessing someone. There do remain being compared against one another. some drawbacks to this though, such as: The first method that will be described, which is also the simplest and most Conor Sheehan University of Strathclyde, 2010
  • 2. In real time the human eye is not landmarks on the subject, such an fast enough to pick up on some example is the Vicon Nexus system. It problem areas works by having a number of the specially Observations may not be designed cameras (usually between 6 and quantitative or objective 12) placed round a walkway or treadmill, Subjects may fatigue if having to where a patient will walk and data is walk for long lengths of time, this picked up from each camera, feeding back could then change their walking information to a main computer. The pattern cameras used are part of the Vicon companies T-series range which states the The use of a camera can help in reducing cameras to be high resolution, high speed these errors, allowing multiple viewing of and highly accurate. The cameras work by the same person’s gait an unlimited shining an infrared (IR) beam that pick up amount of times, the video can also be on markers that have been placed on slowed to frame by frame steps for very anatomical landmarks of the subject, such clear and precise viewing. However they as profound bony landmarks (iliac spines, do bring some of their own problems, like, the malleoli of the ankle, the knee etc.) the true angles made by the subject’s limb the IR light then reflects back off the or the position of the ground reaction markers back into the camera. At any one force (GRF) may not be seen as they truly time there are at least two cameras are. The cameras must also be positioned locked on to any one marker, this is for a correctly and images recorded from both greater information consistency, the data the coronal and sagittal planes. Finally the is then fed back to a computer where camera usually only remains stationary software, “Nexus” in the case in of the and so can only capture the person Vicon Corporation, can produce a 3D walking within a certain area of the image of the sighted object. The program situated camera. can similarly calculate the velocity and There are also more complex digital acceleration of a moving limb/prosthesis systems that use several cameras to give a being worn; it can then display this 3-D shape of the subject and they can be information in a variety of ways. From a used to pick up and located positioned 2D or 3D animation that itself can be Conor Sheehan University of Strathclyde, 2010
  • 3. moved and viewed from any angle or extremely expensive to install and plane as well as being slowed or sped up. upkeep, it needs a skilled operator and The rest of the output information can although fast at processing it is still more display information on body angle time consuming than observational gait movements, where they peak and fall analysis and may not necessarily be able throughout the different phases of gait, to provide any extra information that how long these peaks last for etc. would be of significance to the patient, than that of a trained professionals eye The Vicon Nexus system is probably the could. Finally a lot more space is needed most advanced systems for use in the for both the hard and software to be set study of gait, in comparison to the other up and used. named methods. As stated it is extremely accurate and fast at processing Moving on to the CODA (Cartesian information. Furthermore, according to Optoelectronic Dynamic Anthropometer) Vicon, the set up and use of the software system, which is another type of video is easier to use than previous generation vector system with much of the same of the equipment, “Unlike other Gait functions as the Vicon system. It differs in Analysis systems, working with Vicon’s T- a number of ways though, primarily this Series system doesn’t require an being, as stated by Codamotion its engineering degree.”(2011, web) producer, it is a portable device. Although However, this may be slight bias of the this may be the case, most clinics where it company as this still only applies to a is used keep it remaining in a stationary, skilled person/technician who knows and fixed position. Also unlike Vicon needing understands the usage of the equipment. several cameras positioned round the The markers are also considered to be walking area of the subject, the CODA more confortable to wear for the patient, only need one cx1 unit, which is the base by Vicon, as the indicators are designed to system containing the cameras. From this be light and as they are only required to alone it can “create 3D measurements reflect the infrared light, not have to without the reference of other cameras produce it themselves like other video units” (Codamotion, 2011); however systems, described later. The systems multiple units can be combined to give a main disadvantage is the product is more accurate image. Also to compensate Conor Sheehan University of Strathclyde, 2010
  • 4. for the lack of surrounding cameras, the lot fewer parts that need to be assembled sensors have a wider viewing lens, and positioned with all the main approximately 80 degrees. The markers components remaining in the single base that are attached to the patient also unit. While the use of the software differ; first they are known as active equipment still requires some markers as they produce their own light understanding before use. According to a source, rather than reflecting one Dr Barry Meadows, head of produced by the camera. Due to this Neurobiomechanics at WESTMARK, SGH, though the active markers need an the CODA analytical software can be attached power source known as a taught to someone usually within a day. DriveBox this does make for a more bulky This being in contrast to the “Nexus”, that and heavier wear for the user as well as he said could take up to a week to learn. the fact that wires are needed to attach Continuing on to the Kistler force plate, the markers and DriveBox. The advantage which is a flat moving plate usually built of this method though is the marker can into the ground of a gait lab and usually be programed to know what landmark it is designed to match the flooring as not to and so cannot shift or be confused by the influence the walkers gait or foot position. camera as another anatomical region, The plate can be made in a number of furthermore if the marker is somehow sizes and in the shape of a single slab, but hidden from the sensor by another part of more often it is divided into two, four or the body, the system and software can more segments. The reason for this is, calculate to an highly accurate point the allowing a greater area to place the foot position of where the marker is in relation and the potential ability to get the GRF on to the other selected points. both feet without having the subject have Much like its competitor, Vicon, the to walk twice and hit the plate with the output traits are much the same. It claims opposite side. It is probably the most the software and setup are easier to use, important component in measuring gait. “Working with the Codamotion System Though independently it doesn’t serve doesn't require an engineering degree” much of a purpose, it can be used in (Codamotion, 2011). This may well be true conjunction with the above to calculate to an extent for the setup, as there are a the ground reaction force applied by the Conor Sheehan University of Strathclyde, 2010
  • 5. person and position of the foot, what part correctly stated by Dr Barry Meadows it is of the foot is being used during initial a quicker and less perplexing system to contact and through stance to toe off of learn. that foot. With the aid of a specifically set Although both the above methods are up camera it can also show the direction proven to be better than the conventional and/or magnitude of where the GRF is in visual gait examination and even with the relation to the person on the force plate, allowance of the extra time taken into sometimes this is only done visually with consideration to use either system, it still the length of an indicated arrow on a seems that they would be the more logical computer screen, others it will give the practice used. This remains not the case actual force applied as a number, or due to their high cost which currently at sometimes both ways. the moment cannot be afforded by most From the above finding it is clear that the institutes and clinics, also as the more evidence shows either the Vicon Nexus or advanced methods take longer to run for CODA systems with the aid of the Kistler each patient this is seen as not an efficient force plate are both very equally matched use of time and so is another reason used in use of gait analysis and have a very high against the use of them. Finally at the degree of accuracy if used correctly. The moment as a skilled clinician can usually fact the Vicon system has the greater give just as good a result in determining number of cameras with a wider viewing the main problematic areas and gait sight due to the positioning of the deviations. So it seems unlikely that cameras it is overall the more superior of anything will change until there is a the two giving a better three-dimensional drastic diminishing in the cost of these image. It does appear though, that the innovative systems, the time spent to CODA technology has a few extra added assess a patient is reduced or there are benefits over its counterpart, with it extreme advances in the technology that “technically” being mobile, only needing makes gauging gait significantly better the one base cx1 unit to function thus than the eye of a professional. resulting in less space consumption and if Conor Sheehan University of Strathclyde, 2010
  • 6. Reference List: Figgins, E. 2010, Human Locomotion 6, Observing Gait, National Centre For Prosthetics and Orthotics Meadows, B. 2011, Slide 7, Gait analysis comes in many forms, WESTMARC, SGH Codamotion. 2010a, Advantages & Capabilities [online]. Charnwood Dynamics Ltd, Available at: http://www.codamotion.com/clinical-advantages-capabilities.html [6th March 2011]. Codamotion. 2010b, Movement Analysis With CODA – Overview [online]. Charnwood Dynamics Ltd, Available at: http://www.codamotion.com/engineering-systems-overview.html [6th March 2011]. Kistler. 2011a, Motion and gait analysis [online]. Kistler Holding AG, Available at: http://www.kistler.com/us_en-us/62_Biomechanics_Analysis/Motion-and-gait- analysis.html [7th March 2011]. Kistler. 2011b, Why Kistler force plates? [online]. Kistler Holding AG, Available at: http://www.kistler.com/us_en-us/64_Biomechanics_Kistler/Why-Kistler-force- plates.html [7th March 2011]. Vicon. 2011a, Gait Analysis+Rehabilitation[online]. OMG plc, Available at: http://www.vicon.com/applications/gait_analysis.html [6th March 2011]. Vicon. 2011b, Vicon Nexus [online]. OMG plc, Available at: http://www.vicon.com/products/nexus.html [5th March 2011]. Vicon. 2011c, Vicon T-Series and T-Series S Edition[online]. OMG plc, Available at: http://www.vicon.com/products/tseries.html [5th March 2011]. Wikipedia. 2011, Gait analysis [online]. Available at: http://en.wikipedia.org/wiki/Gait_analysis [9th March 2011]. Wikipedia. 2011, IMRAD [online]. Available at: http://en.wikipedia.org/wiki/IMRAD [8th March 2011]. Conor Sheehan University of Strathclyde, 2010