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Research Papers

Operator Bias Errors Are Reduced Using Standing Marker Alignment Device for Repeated Visit Studies

[+] Author and Article Information
Laura Hutchinson

Department of Mechanical
and Materials Engineering,
Human Mobility Research Centre,
Queen's University Kingston,
130 Stuart Street,
Kingston, ON K7 L 3N6, Canada
e-mail: laura.hutchinson@queensu.ca

Joel B. Schwartz

Sproutel,
60 Valley Street, Suite 105,
Providence, RI 02909
e-mail: joelbschwartz@gmail.com

Amy M. Morton

Department of Mechanical
and Materials Engineering,
Human Mobility Research Centre,
Queen's University Kingston,
130 Stuart Street,
Kingston, ON K7 L 3N6, Canada
e-mail: amy_morton1@brown.edu

Irene S. Davis

Spaulding National Running Centre,
Harvard Medical School,
Spaulding-Cambridge Outpatient Center,
1575 Cambridge Street,
Cambridge, MA 02138
e-mail: mcclay@udel.edu

Kevin J. Deluzio

Department of Mechanical
and Materials Engineering,
Human Mobility Research Centre,
Queen's University Kingston,
130 Stuart Street,
Kingston, ON K7 L 3N6, Canada
e-mail: kevin.deluzio@queensu.ca

Michael J. Rainbow

Department of Mechanical
and Materials Engineering,
Human Mobility Research Centre,
Queen's University Kingston,
130 Stuart Street,
Kingston, ON K7 L 3N6, Canada
e-mail: michael.rainbow@queensu.ca

1Corresponding author.

Manuscript received April 25, 2017; final manuscript received October 28, 2017; published online January 19, 2018. Assoc. Editor: Pasquale Vena.

J Biomech Eng 140(4), 041001 (Jan 19, 2018) (7 pages) Paper No: BIO-17-1174; doi: 10.1115/1.4038358 History: Received April 25, 2017; Revised October 28, 2017

When optical motion capture is used for motion analysis, reflective markers or a digitizer are typically used to record the location of anatomical landmarks identified through palpation. The landmarks are then used to construct anatomical coordinate systems. Failure to consistently identify landmarks through palpation over repeat tests creates artifacts in the kinematic waveforms. The purpose of this work was to improve intra- and inter-rater reliability in determining lower limb anatomical landmarks and the associated anatomical coordinate systems using a marker alignment device (MAD). The device aids the subject in recreating the same standing posture over multiple tests, and recreates the anatomical landmarks from previous static calibration trials. We tested three different raters who identified landmarks on eleven subjects. The subjects performed walking trials and their gait kinematics were analyzed with and without the device. Ankle kinematics were not improved by the device suggesting manual palpation over repeat visits is just as effective as the MAD. Intra-class correlation coefficients between gait kinematics registered to the reference static trial and registered to follow-up static trials with and without the device were improved between 1% and 33% when the device was used. Importantly, out-of-plane hip and knee kinematics showed the greatest improvements in repeatability. These results suggest that the device is well suited to reducing palpation artifact during repeat visits to the gait lab.

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References

Kadaba, M. P. , Ramakrishnan, H. K. , and Wootten, M. E. , 1990, “ Measurement of Lower Extremity Kinematics During Level Walking,” J. Orthop. Res., 8(3), pp. 383–392. [CrossRef] [PubMed]
Frigo, C. , Rabuffetti, M. , Kerrigan, D. C. , Deming, L. C. , and Pedotti, A. , 1998, “ Functionally Oriented and Clinically Feasible Quantitative Gait Analysis Method,” Med. Biol. Eng. Comput., 36(2), pp. 179–185. [CrossRef] [PubMed]
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Noonan, K. J. , Halliday, S. , Browne, R. , O'Brien, S. , Kayes, K. , and Feinberg, J. , 2003, “ Interobserver Variability of Gait Analysis in Patients With Cerebral Palsy,” J. Pediatr. Orthop., 23(3), pp. 279–287. http://journals.lww.com/pedorthopaedics/Abstract/2003/05000/Interobserver_Variability_of_Gait_Analysis_in.1.aspx [PubMed]
Noehren, B. , Manal, K. , and Davis, I. , 2010, “ Improving Between-Day Kinematic Reliability Using a Marker Placement Device,” J. Orthop. Res., 28(11), pp. 1405–1410. [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 3

Root-mean-square (RMS)error computed between operator 1 placing the markers (solid line) and replacing the markers (light grey, dashed line) over the whole gait cycle, compared to the RMS computed between operator 1 placing the markers and the MAD replacing the markers (dark grey, dashed line) over the whole gait cycle

Grahic Jump Location
Fig. 2

Fixed markers on the MAD (grey, solid) are used to construct a MADCS. (a) On a first visit, anatomical markers (black, solid) and tracking markers (white, solid, black outline) are placed on the participant. The participant stands in the MAD, and anatomical markers are registered to the MADCS and recorded for future visits. Anatomical and tracking markers are registered to the global coordinate system for motion analysis. (b) On a repeat visit, only tracking markers (white, solid, black outline) are placed on the participant. The participant uses the physical guides of the MAD to reproduce their original posture (dotted line). With the participant realigned in the MADCS, anatomical markers from their first visit can be virtually reconstructed (grey, solid, black outline). Virtual anatomical markers and physical tracking markers are registered to the global coordinate system for motion analysis. (c) Motion analysis of tracking markers is performed identically for the real and virtual anatomical marker sets.

Grahic Jump Location
Fig. 1

Side (a) and top (b) views of the MAD showing the two posterior supports, two foot plates, and base plate

Grahic Jump Location
Fig. 4

Joint angles of a single participant, single operator during normal walking. Comparing the reference static (grey, solid), to the reapplication static of the same operator (light grey, dashed), to the recreation of the MAD (dark grey, dashed). The differences seen here are a combination of offset as well as differences in shape.

Grahic Jump Location
Fig. 5

Joint angles for a single participant during normal walking. Comparing the reference static (grey, solid), to the reapplication of markers by two different operators (thick lines), to the recreation using the MAD (thin lines).

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