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Article ; Online: Clinical gait analysis 1973-2023: Evaluating progress to guide the future.

Stebbins, Julie / Harrington, Marian / Stewart, Caroline

2023 Volume 160, Page(s) 111827

Abstract: Clinical gait analysis has been used to inform treatment for over 50 years. Over that period there have been significant advances in motion capture technology and software development, driven in part by innovations in biomechanics. The aim of this paper ... ...

Abstract	Clinical gait analysis has been used to inform treatment for over 50 years. Over that period there have been significant advances in motion capture technology and software development, driven in part by innovations in biomechanics. The aim of this paper is to review the current state of the art in gait analysis, mapping progress over the last five decades using the collective experience of the community of researchers and clinicians.An online survey was circulated to gait analysts to canvas opinion and responses were received from 229 people from 28 countries.Respondents identified the greatest progress in the areas of hardware, automation of processes, and software development. Despite laboratories being better equipped, many of today's challenges would have been very familiar to those working in 1973. Better algorithms and more evidence are needed to establish a secure link between gait analysis data and clinical decision making. Biomechanical models require further refinement to overcome well known limitations. Despite innovation, clinical gait analysis remains relatively unknown in the wider healthcare field.Growth in the global Gait Analysis communities and advances in remote communication technology have created new opportunities for taking on this challenge over the next 50 years. Hopefully, future innovation will lead to clinical gait analysis becoming more accessible, more flexible to real world mobility and more able to exploit emerging advanced modelling techniques.
Language	English
Publishing date	2023-10-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	218076-5
ISSN	1873-2380 ; 0021-9290
ISSN (online)	1873-2380
ISSN	0021-9290
DOI	10.1016/j.jbiomech.2023.111827
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Article ; Online: Using surface markers to describe the kinematics of the medial longitudinal arch.

Uhan, Jerneja / Kothari, Alpesh / Zavatsky, Amy / Stebbins, Julie

Gait & posture

2023 Volume 102, Page(s) 118–124

Abstract: Background: Static and dynamic assessment of the medial longitudinal arch (MLA) is an essential aspect for measuring foot function in both clinical and research fields. Despite this, most multi-segment foot models lack the ability to directly track the ... ...

Abstract	Background: Static and dynamic assessment of the medial longitudinal arch (MLA) is an essential aspect for measuring foot function in both clinical and research fields. Despite this, most multi-segment foot models lack the ability to directly track the MLA. This study aimed to assess various methods of MLA assessment, through motion capture of surface markers on the foot during various activities. Methods: Thirty general population participants (mean age 20 years) without morphological alterations to their feet underwent gait analysis. Eight measures, each representing a unique definition of the MLA angle using either real only, or both real and floor-projected markers, were created. Participants performed tasks including standing, sitting, heel lift, Jack's test and walking, and had their Arch Height Index (AHI) measured using callipers. Multiple-criteria decision analysis (MCDA) with 10 criteria was utilised for selecting the optimal measure for dynamic and static MLA assessment. Results: In static tasks, the standing MLA angle was significantly greater in all measures but one when compared to sitting, Jack's test and heel lift. The MLA angle in Jack's test was significantly greater than in heel lift in all measures. Across the compared dynamic tasks, significant differences were noted in all measures except one for foot strike in comparison to 50% gait cycle. All MLA measures held significant inverse correlations with MLA measured from static and dynamic tasks. Based on MCDA criteria, a measure comprising the first metatarsal head, fifth metatarsal base, navicular and heel markers was deemed the best for MLA assessment. Significance: This study aligns with the current literature recommendations for the use of a navicular marker for characterising the MLA. It contrasts with previous recommendations and advocates against the use of projected markers in most situations.
MeSH term(s)	Humans ; Young Adult ; Adult ; Biomechanical Phenomena ; Foot/anatomy & histology ; Gait ; Walking ; Tarsal Bones/anatomy & histology
Language	English
Publishing date	2023-03-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2023.03.016
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Article ; Online: Efficacy of quantifying marker-cluster rigidity in a multi-segment foot model: a Monte-Carlo based global sensitivity analysis and regression model.

Chan, Po-Hsiang / Stebbins, Julie / Zavatsky, Amy B

Computer methods in biomechanics and biomedical engineering

2021 Volume 25, Issue 3, Page(s) 308–319

Abstract: Marker-based clinical gait analysis and multi-segment foot models (MSFM) have been successfully used for the diagnosis and clinical management of various lower limb disorders. The accuracy and validity of the kinematics measured depend on the design of ... ...

Abstract	Marker-based clinical gait analysis and multi-segment foot models (MSFM) have been successfully used for the diagnosis and clinical management of various lower limb disorders. The accuracy and validity of the kinematics measured depend on the design of the model, as well as on the adherence to its inherent rigid body assumption. This study applies a Monte-Carlo based global sensitivity analysis to evaluate the efficacy of using 'rigid body error (
MeSH term(s)	Biomechanical Phenomena ; Foot ; Gait ; Gait Analysis ; Lower Extremity
Language	English
Publishing date	2021-07-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2071764-7
ISSN	1476-8259 ; 1025-5842
ISSN (online)	1476-8259
ISSN	1025-5842
DOI	10.1080/10255842.2021.1954170
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Article ; Online: Effect of entraining oxygen at different locations in a noninvasive ventilator.

Stebbins, Julie / Saigal, Raveen / Hooper, Robbie / Shortland, Adam

British journal of anaesthesia

2020 Volume 125, Issue 6, Page(s) e483–e485

MeSH term(s)	Air Pressure ; Continuous Positive Airway Pressure ; Humans ; Noninvasive Ventilation/methods ; Oxygen Inhalation Therapy/methods ; Respiratory Mechanics ; Ventilator Weaning
Keywords	covid19
Language	English
Publishing date	2020-09-09
Publishing country	England
Document type	Letter
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2020.09.006
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Article ; Online: Advanced Robotics to Address the Translational Gap in Tendon Engineering.

Sander, Iain L / Dvorak, Nicole / Stebbins, Julie A / Carr, Andrew J / Mouthuy, Pierre-Alexis

Cyborg and bionic systems (Washington, D.C.)

2022 Volume 2022, Page(s) 9842169

Abstract: Tendon disease is a significant and growing burden to healthcare systems. One strategy to address this challenge is tissue engineering. A widely held view in this field is that mechanical stimulation provided to constructs should replicate the mechanical ...

Abstract	Tendon disease is a significant and growing burden to healthcare systems. One strategy to address this challenge is tissue engineering. A widely held view in this field is that mechanical stimulation provided to constructs should replicate the mechanical environment of native tissue as closely as possible. We review recent tendon tissue engineering studies in this article and highlight limitations of conventional uniaxial tensile bioreactors used in current literature. Advanced robotic platforms such as musculoskeletal humanoid robots and soft robotic actuators are promising technologies which may help address translational gaps in tendon tissue engineering. We suggest the proposed benefits of these technologies and identify recent studies which have worked to implement these technologies in tissue engineering. Lastly, key challenges to address in adapting these robotic technologies and proposed future research directions for tendon tissue engineering are discussed.
Language	English
Publishing date	2022-09-15
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2692-7632
ISSN (online)	2692-7632
DOI	10.34133/2022/9842169
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Article ; Online: Responsiveness of the Foot Profile Score in children with hemiplegia.

McCahill, Jennifer / Stebbins, Julie / Prescott, Robin J / Harlaar, Jaap / Theologis, Tim

Gait & posture

2022 Volume 95, Page(s) 160–163

Abstract: Background: The Foot Profile Score (FPS) is a single score that summarises foot posture and dynamic foot motion during the gait cycle based on the kinematic data of the Oxford Foot Model. The FPS enables clinicians and researchers to quantify foot ... ...

Abstract	Background: The Foot Profile Score (FPS) is a single score that summarises foot posture and dynamic foot motion during the gait cycle based on the kinematic data of the Oxford Foot Model. The FPS enables clinicians and researchers to quantify foot abnormalities during gait, to monitor change in foot/ankle motion over time, and to measure the outcome of intervention. With the creation of a new outcome measure, it is important to test its responsiveness in a clinical population for whom it may be sensitive to change. Aim: To evaluate the responsiveness of the FPS in a clinical population following isolated foot and ankle surgery. Methods: Using previous work completed to validate the FPS, we defined the minimal clinically important difference (MCID) for the FPS. Using this MCID, we applied it to a clinical population of 37 children with cerebral palsy, spastic hemiplegia, comparing their FPS before and after foot and ankle surgery. A regression analysis looked at potential relationships between the change in FPS and their pre-operative FPS, age at surgery, and time since surgery. Results: An MCID of 2.4 degrees was calculated through regression analysis. The mean change from the pre-operative FPS to the post-operative FPS was 4.6 (SD 3.7 with a range from -0.1 to 13.4). Twenty-eight children (76%) had a change in their FPS greater than the MCID. A regression analyses only showed a clear regression between pre-operative FPS and change in FPS (R2 = 0.58 p < 0.01).
MeSH term(s)	Biomechanical Phenomena ; Cerebral Palsy/complications ; Cerebral Palsy/surgery ; Child ; Gait ; Hemiplegia ; Humans ; Lower Extremity
Language	English
Publishing date	2022-04-19
Publishing country	England
Document type	Journal Article
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2022.04.012
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Article ; Online: Anatomical masking of pressure footprints based on the Oxford Foot Model: validation and clinical relevance.

Giacomozzi, Claudia / Stebbins, Julie A

Gait & posture

2017 Volume 53, Page(s) 131–138

Abstract: Plantar pressure analysis is widely used in the assessment of foot function. In order to assess regional loading, a mask is applied to the footprint to sub-divide it into regions of interest (ROIs). The most common masking method is based on geometric ... ...

Abstract	Plantar pressure analysis is widely used in the assessment of foot function. In order to assess regional loading, a mask is applied to the footprint to sub-divide it into regions of interest (ROIs). The most common masking method is based on geometric features of the footprint (GM). Footprint masking based on anatomical landmarks of the foot has been implemented more recently, and involves the integration of a 3D motion capture system, plantar pressure measurement device, and a multi-segment foot model. However, thorough validation of anatomical masking (AM) using pathological footprints has not yet been presented. In the present study, an AM method based on the Oxford Foot Model (OFM) was compared to an equivalent GM. Pressure footprints from 20 young healthy subjects (HG) and 20 patients with clubfoot (CF) were anatomically divided into 5 ROIs using a subset of the OFM markers. The same foot regions were also identified by using a standard GM method. Comparisons of intra-subject coefficient of variation (CV) showed that the OFM-based AM was at least as reliable as the GM for all investigated pressure parameters in all foot regions. Clinical relevance of AM was investigated by comparing footprints from HG and CF groups. Contact time, maximum force, force-time integral and contact area proved to be sensitive parameters that were able to distinguish HG and CF groups, using both AM and GM methods However, the AM method revealed statistically significant differences between groups in 75% of measured variables, compared to 62% using a standard GM method, indicating that the AM method is more sensitive for revealing differences between groups.
Language	English
Publishing date	2017-03
Publishing country	England
Document type	Journal Article
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2016.12.022
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Article ; Online: Marker cluster rigidity in a multi-segment foot model.

Chan, Po-Hsiang / Stebbins, Julie / Zavatsky, Amy B

Journal of biomechanics

2019 Volume 84, Page(s) 284–289

Abstract: Multi-segment foot models (MSFM) are used in gait analysis for the diagnosis and planning of treatment for patients with foot deformities. Like other biomechanical models, MSFMs represent the leg and foot as a series of linked rigid segments, but such a ... ...

Abstract	Multi-segment foot models (MSFM) are used in gait analysis for the diagnosis and planning of treatment for patients with foot deformities. Like other biomechanical models, MSFMs represent the leg and foot as a series of linked rigid segments, but such a simplification may not be appropriate, particularly for the flexible forefoot. This study investigated the appropriateness of the rigid body assumption on marker clusters used to define the individual segments (tibia, hindfoot, forefoot) of a widely-used MSFM. Rigidity of the marker clusters was quantified using the rigid body error (σ
MeSH term(s)	Adult ; Biomechanical Phenomena ; Female ; Foot/anatomy & histology ; Foot/physiology ; Gait Analysis ; Humans ; Male ; Mechanical Phenomena ; Models, Biological
Language	English
Publishing date	2019-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	218076-5
ISSN	1873-2380 ; 0021-9290
ISSN (online)	1873-2380
ISSN	0021-9290
DOI	10.1016/j.jbiomech.2018.12.045
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Article ; Online: Multi-segment foot models and their use in clinical populations.

Leardini, Alberto / Caravaggi, Paolo / Theologis, Tim / Stebbins, Julie

Gait & posture

2019 Volume 69, Page(s) 50–59

Abstract: Background: Many multi-segment foot models based on skin-markers have been proposed for in-vivo kinematic analysis of foot joints. It remains unclear whether these models have developed far enough to be useful in clinical populations. The present paper ... ...

Abstract	Background: Many multi-segment foot models based on skin-markers have been proposed for in-vivo kinematic analysis of foot joints. It remains unclear whether these models have developed far enough to be useful in clinical populations. The present paper aims at reviewing these models, by discussing major methodological issues, and analyzing relevant clinical applications. Research question: Can multi-segment foot models be used in clinical populations? Methods: Pubmed and Google Scholar were used as the main search engines to perform an extensive literature search of papers reporting definition, validation or application studies of multi-segment foot models. The search keywords were the following: 'multisegment'; 'foot'; 'model'; 'kinematics', 'joints' and 'gait'. Results: More than 100 papers published between 1991 and 2018 were identified and included in the review. These studies either described a technique or reported a clinical application of one of nearly 40 models which differed according to the number of segments, bony landmarks, marker set, definition of anatomical frames, and convention for calculation of joint rotations. Only a few of these models have undergone robust validation studies. Clinical application papers divided by type of assessment revealed that the large majority of studies were a cross-sectional comparison of a pathological group to a control population. Significance: This review suggests that there is sufficient evidence that multi-segment foot models may be successfully applied in clinical populations. Analysis of the currently available models allows users to better identify the most suitable protocol for specific clinical applications. However new models require thorough validation and assessment before being used to support clinical decisions.
MeSH term(s)	Biomechanical Phenomena ; Cross-Sectional Studies ; Foot/anatomy & histology ; Foot Joints/anatomy & histology ; Gait/physiology ; Humans ; Models, Biological
Language	English
Publishing date	2019-01-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2019.01.022
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Article ; Online: ISB recommendations for skin-marker-based multi-segment foot kinematics.

Leardini, Alberto / Stebbins, Julie / Hillstrom, Howard / Caravaggi, Paolo / Deschamps, Kevin / Arndt, Anton

Journal of biomechanics

2021 Volume 125, Page(s) 110581

Abstract: The foot is anatomically and functionally complex, and thus an accurate description of intrinsic kinematics for clinical or sports applications requires multiple segments. This has led to the development of many multi-segment foot models for both ... ...

Abstract	The foot is anatomically and functionally complex, and thus an accurate description of intrinsic kinematics for clinical or sports applications requires multiple segments. This has led to the development of many multi-segment foot models for both kinematic and kinetic analyses. These models differ in the number of segments analyzed, bony landmarks identified, required marker set, defined anatomical axes and frames, the convention used to calculate joint rotations and the determination of neutral positions or other offsets from neutral. Many of these models lack validation. The terminology used is inconsistent and frequently confusing. Biomechanical and clinical studies using these models should use established references and describe how results are obtained and reported. The International Society of Biomechanics has previously published proposals for standards regarding kinematic and kinetic measurements in biomechanical research, and in this paper also addresses multi-segment foot kinematics modeling. The scope of this work is not to prescribe a particular set of standard definitions to be used in all applications, but rather to recommend a set of standards for collecting, calculating and reporting relevant data. The present paper includes recommendations for the overall modeling and grouping of the foot bones, for defining landmarks and other anatomical references, for addressing the many experimental issues in motion data collection, for analysing and reporting relevant results and finally for designing clinical and biomechanical studies in large populations by selecting the most suitable protocol for the specific application. These recommendations should also be applied when writing manuscripts and abstracts.
MeSH term(s)	Biomechanical Phenomena ; Foot ; Foot Joints ; Gait ; Skin
Language	English
Publishing date	2021-06-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	218076-5
ISSN	1873-2380 ; 0021-9290
ISSN (online)	1873-2380
ISSN	0021-9290
DOI	10.1016/j.jbiomech.2021.110581
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