CHAPTER ONE

1.0 Introduction

The way how a person walks is called gait. Another good definition can be “a
coordinated action of neuromuscular and skeletomuscular systems. Gait disorders
resulting in uncontrollable walking patterns may be due to diseases such as Parkinson,
Epilepsy, Arthritis, Fracture, Injuries, Collision and many other diseases can cause
neurological disorder or motor paralysis. These disorders can be either in one body part
or throughout the body without confining to any specific age group.

Experiments can be performed on different gait parameters like body velocity, time ratio,
ground slope, stance/swing, body gestures and gait patterns. Sensors can be put on hips,
knees, thighs, limbs, neck, head, chest or any other suitable body part to capture motion
data for further pre-and post-processing.

1.1 Background of Study

Movement is very essential in our lives as it determines the activities we engage in and
also because it is an inevitable part of the human cycle. But it can be affected by many
things especially Trauma, Disease or Ageing so it is important to know who is safe or at
risk and to accurately quantify how we move. Hence it is imperative on the Engineering
profession to develop a device to help tackle the situation, which brings about the need
for motion sensors. Motion sensor signals were very hard to interprete (Dr B.Mariani et
al., 2014). but thanks to modern innovation it is now a thing of the past.

Orthotics and prosthetics science is one of the most intimate meeting points between
technology and human beings. The term orthotics is defined as “The field of design and
fabrication of the devices to replace a body part”[2]. While the term prosthetics is
defined as “The field of design and fabrication of any type of brace device” [2].
Amputation is the removal of a limb or other appendage or outgrowth of the body.
Amputation frequently requires support from orthotics and prosthetics technology. These
technologies enable the design and manufacture of safe, stable, and comfortable
prostheses. Because “Amputation produces a deep physical and emotional response in
the patient” [3], good prosthesis design helps amputees to live normal lives and regain
their confidence.
Lower limb amputations appear most frequently in medical amputation cases, “There are
at least 10 times more lower extremity amputations than there are upper extremity
amputations” (in the US) [2]. A Lower Limb Amputation can be further classified as
Syme’s, Transtibial, knee disarticulation, transfemoral, and hip disarticulation. Syme’s
amputation removes the medial and lateral malleolus. While transtibial is the removal of
the limb above the foot and below knee. Transfemoral is the amputation of the limb
between knee and hip. Hip disarticulation removes whole lower limb including hip.
There are various differences between these amputations for prosthesis designers
regarding energy cost or force conduction. Because of these factors, well-designed or
anatomical prostheses are highly desired by the Lower Limb Amputation patients.
However, Pawlikowski, et al. point out that “a high number of custom-designed
prostheses are prone to failure” due to designers’ limited “experience and knowledge of
load transfer mechanism”[4].

As a consequence, it is necessary to analyze the force and load that will be applied to the
prosthesis during the prosthesis design process. According to Florschutz, et al. study of
osseointegrated tantalum implants, mechanical testing and histology shows tighter
implant fixation over time, but “the implants had stiffness and maximum torque to failure
measurements that were significantly lower than intact controls”.[5]

1.2 Statement of the Problem

Most of the patients suffering from any neurological disorder at their later stages of
disease pose ambulatory disturbance. Such patients may even fall without showing any
warning sign. Falls are considered one of the major causes of injury, disability, cost and
mortality. For above, different gait related parameters need to study. There may need a
systematic tool to take measurements as well.

Finally, there is a need to develop a mechanism to detect any gait deviation notifying 3rd
party in the form of security alarms.

1.3 Justification of the Study

Actually, there is not such a smooth mechanism to monitor human gait. We need to
develop such an efficient and adaptive method so that a user can set own sampling rate
and thresholds. The main motivation to perform this experimental research work is to
detect any gait deviation for the patient with PD. Security alarms can be activated
whenever a patient poses shakier gait. Two types of alarms or sirens can be activated in
the algorithm, first to activate Warning Alarms when the value from motion data exceeds
minimum threshold value and second to activate Emergency Alarms when value from
motion data exceeds maximum threshold value.

1.4 Aim and Objectives of the Study

The aim of this project is to offer mobile real-time gait analysis for PD patients, and
remote monitoring and control by caretakers. The summarised objectives are listed
below.

1. Provide PD patients with an easy to use mobile gait analysis device

i. Enhance daily life of PD patients

ii. Improve independence of PD patients

2. Provide caretakers with an effective remote monitoring and control tool for PD
patients

1.5 Scope of the Study

Wireless Sensor Network (WSN) technologies, has become business of billions of

dollars ($25 Billion in 2012) for healthcare services for indoor patients, monitoring
chronic disease and elderly persons. Few in such applications are wireless ambulatory
cardiac & diabetic monitoring systems and tracking different neurological disorders.
These applications are increasing during the past few years for improving daily life
health facilities and wellness solutions.

1.6 Limitation of the Study

For the sake of this study, analysis and processing of the raw sensor data wont be carried
out as it is beyond the scope of the study.

1.7 Expected Contribution to Knowledge

The study is expected to improve the students knowledge of animal locomotion.

Knowledge of Parkinson’s Disease is acquired also during the course of this research.
CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

A US patent device for monitoring real time deviations in the patients’ gait is proposed.
This device is useful to wear partially inside the auditory canal equipped with
accelerometer and gyroscope. Subsequent current gait features are extracted continuously
to compare with accumulated gait statistics to find the deviation in gait patterns.
Functioning of this device is based on some important facts. One such fact is that
neurological disorders possess unique identifiable characteristics. For example, small
shuffling steps can be detected from forward velocity, vertical acceleration and step
frequency. These authors also describe that small rapid stepping (Festination) and
backward steps can be detectable by

signature identifier. Vertical acceleration can be detected through 3-axis accelerometer

which should be sensitive to low frequency, low amplitude motion and low energy
consumable. They also stress to use a gyroscope in combination with accelerometer for
accurate horizontal movement of the individual’s head. Above authors suggest to use
predefined gait features for an indication that a person is falling or prone to fall. If an
individual is about to fall then system is configured to notify a third party and warn
individual with postural instability as well [6].

Another related work is done by Toshiyo et al [23] in which a wearable automatic airbag
opens when a fall occurs based on acceleration and angular velocity. They incorporate a
fall-sensing algorithm in the form of a wearable smart jacket to protect head and hip,
when value exceeds to the threshold limit. So this algorithm is proved helpful to avoid
fall injuries thus saves lives at construction sites and other locations. The authors have
used accelerometers and gyroscope in their studies.

Our proposed method works on some of features mentioned above. Some of these
characteristics are as given: Our efficient and sensitive algorithm can be used to detect a
small deviation in the gait in all three axis setting threshold values using wireless triaxial
accelerometers. Step counts, vertical acceleration to detect fall, notifying a third party &
individual itself are features described in our proposed system as well.
Another step detection algorithm for PD is implemented. This method is based on
calculating standard deviation as the basic parameter which will be lower in case of
shuffling gait. In the post-processing environment, the threshold value is calculated to be
25% of total standard deviation while it is 20% after trying different values in range 20-
33% in real-time scenario. In order to track the motion initially for 60 seconds, a concept
of rotating windows is used to make the calculation light. This rotating window uses
array to hold 100 values to take next action and for each specific second 200 new values
are received. Thus, for each 60 second of the period, 12,000 values are received [5].

Figure 1: Test person in a current gait analysis laboratory

2.4 Gait Analysis

Gait analysis is primarily used as an objective and quantitative method to record the
effectiveness of physical therapy. it is a method of recording the way people are walking
in many different ways. Melmick et al (2002) emphasized that dSuring the gait analysis,
three characteristics are measured: the temporal, kinetic and kinematic aspects of the gait

2. Importance and Roles of Gait Analysis

It is obvious that maintaining proper functionality of gait performance will lead to

healthier and happier life. Research on gait analysis unfolds a new horizon beyond the
boundaries of clinical and pathologic gait diagnosis, monitoring sports and athletic
performances, observation of training and rehabilitation exercises, and designing
anthropomorphic gait, exoskeletal systems, and prosthetic limbs.
Clinical gait analysis refers to the study on clinical approach and techniques to the
assessment of gait disorder or gait abnormalities. Abnormal gait is the main cause for
most of the physical problems, such as back pain, joint pain at the lower limbs, muscle
strain, etc.13 On the other hand, gait abnormalities could happen for various reasons, like
biomechanical problems, injuries, stroke, fracture, neurological disorder, and so on.14 In
both of the cases, gait analysis plays a significant role in health diagnosis and monitoring
gait performances. The main concern of clinical gait analysis is to study balanced
distribution of loads in quiet standing and symmetry of motion pattern, cadence, and
forces sharing during gait performance.24

Gait and motion analysis are vital in observing and monitoring various sports
performances depending on both kinematic and dynamic properties of limb and multi-
limb behavior.28,46 Observing gait style of a runner and continuous practice to improve, if
there are any gait abnormalities, will increase efficiency of running and also reduce
injury risk.46,162 With the advancement of research and technology, gait analysis provides
a great opportunity to characterize a person’s running gait whether it follows a natural
running pattern or have any type of abnormalities, such as, over-pronation or asymmetry
in motion trajectories.46

Robot assisted rehabilitation exercise is one of the technological prospects to recover

limbs movement functions in a maximal degree. On the other hand, robot assisted gait
enhancement insures more working power and capabilities without growing muscle
fatigue.28 For both of the cases, joints and limbs motion trajectories need to comply with
natural gait and motion pattern where the main challenge is to manage limbs impedance
to follow smooth trajectory patterns ensuring avoidance of any secondary injuries.30,184
Again, to provide functional needs of gait locomotion to amputees, instrumented gait
analysis in prosthetics allows better understanding and insights of adaptive mechanisms
of lower limbs in walking and running.222,223

3. Common Technologies Used in Gait Analysis

3.1. Independent system

3.1.1. Motion capture cameras

One of the established techniques of gait analysis is the use of motion capture camera.
Although a number of researchers are trying to establish various strategies in
representation, characterization, and recognition of human gait, it is really a challenging
job to extract targeted and suitable features from image sequence. Targeted features
could be joint positions, joint motion trajectories, and joint angle variations during
walking. Gait motion can be analyzed with or without having any marker attached on
human body.2,15 This technique can be used both for 2D or 3D analysis of human gait. A
single camera is commonly used to acquire data for 2D analysis.16,17 In this case, the
camera is placed in parallel with subject’s plane of motion of interest. One of the
limitations of this technique is out-of-plane movement that leads the analysis to unusual
outputs.2 This problem can be overcome using treadmill walking. For 3D analysis, more
than one camera is needed with complex setup as the observation should focus on all
planes of movements.18 As 3D analysis requires reconstruction of the points of interests
on the subject for all the time, the points should be visible for at least two cameras for
every moment.2,20 While using markers, the skin movement artifacts over the
musculoskeletal system should be eliminated from the captured data before the
reconstruction of motion.20 For the uses of camera, 60 Hz is adequate for kinematic
analysis while the subject is on normal walking speed.2 But for faster locomotion it needs
to increase the frequency of data sampling rate where extra lighting mechanism is
required.20 Another challenge of using camera is the angle of view and focal distance that
impose limit on the size of capture volume.

3.1.2. Optoelectronic system

Another technique of human gait analysis is well known where active or passive markers
are attached with the point of interest of human body.15 These marker points are traced
by optoelectronic system that converts the emitted or reflected light signals from the
markers into electrical signals.2,15,24 These electrical signals are used to construct models
for gait analysis. The active markers emit light signals where small LEDs could be used
to attach with the point of interest of the subject. On the other hand, the passive markers
reflect the lights coming from the optoelectronic device where Infra Red (IR) light is
used to illuminate the markers.15,24 Although the sampling rate of an optoelectronic
system varies within the range of 50 Hz to 1 KHz, it does not increase the accuracy
significantly for a quicker movement rather than slow walking.2 Some optoelectronic
devices, like Kinect sensor, use array of camera and depth sensors to produce 3D virtual
model of skeleton for gait analysis.25 This system has already been used in several
researches, most importantly for clinical application and presents some good and reliable
results.26,27,29

3.1.3. Inertial system

Inertial system accumulates accelerometers and gyroscopes together and works on the
principle of inertial measurements. Accelerometer and gyroscope provide the data of
acceleration and orientation of the attached point through which segment acceleration,
segment orientation, and joint position can be achieved for gait analysis.24,40,41,211,212 The
sampling rate both for accelerometer and gyroscope are same and vary from 100 Hz to
10 KHz.2,42 The tri-axial acceleration and gyration capabilities provide the facilities to
analyze human locomotion in 3D environ- ment.28,43 The sensors are small, light weight,
and capable to detect a large range of angular velocity and acceleration. Usages of
smartphones and portable media devices with integrated inertial sensors unfold a new
dimension in gait analysis and monitoring.224 The disadvantage of using this system is
the skin movement artifacts which can affect the reading of acceleration and gyration.2 It
is also a challenging task to identify the segment length and exact rotational axis.15
Moreover, the acceleration is relative to the position of the Inertial Measurement Unit
(IMU)

system.24

3.1.4. Electrogoniometer

Electrogoniometer (EGM) is an electro-mechanical instrument to measure angles of joint

movements and also used in gait analysis.15 Basically two types of EGM are used, such
as, Potentiometric EGM (pEGM), and Flexible EGM (fEGM).22 For pEGM, a
potentiometer is used at the joint rotational axis of two arms.24,210 These arms are
normally attached with the two segments of a particular joint of musculoskeletal system
especially at the knee of the lower limbs. Major challenge in capturing knee movement
information for walking is to co-relate the knee-joint axis with the system joint axis. To
provide this facility, some flexibility is necessary at the attachment point of the
instrumentation with limb segments.210 This problem can be overcome in fEGM system
as flexible spring transducer and optical fiber are used in fEGM system with a fixed end
and a telescopic end block.22 For both systems (pEGM and fEGM), when leg moves,
EGM converts the mechanical signals into electrical signals. The drawbacks of the
systems are: the angle movements can be measured only for one plane and accurate
calibration is needed for the joint axis.15,24 Moreover, the instrument is uncomfortable to
wear and much difficult to fit with the joint having more than one Degree of Freedom
(DoF) like hip or ankle joint. Research shows that, though the system produces good
results for elbow joint but does not show the same good quality data while using at the
knee joint.2

3.2. Partially independent system

3.2.1. Gait mat/pressure mat

Gait mat is a special kind of carpet where an arrangement of sensors is embedded.30 The
geometry of the mat is pre-determined and the sensors of the mat are able to sense the
foot contact as well as the GRF while walking. The uses of gait mat and pressure mat are
almost similar to force plate.30 Portability, low cost, and nonactive attachments with
subject are the advantages of using the system. Most importantly the system provides a
good dataset of foot contact, step and stride length, distributed pressure, and GRF. The
limitation of these systems is the resolutions of the sensing points because of the finite
size of the sensors.31 Moreover, increased resolution will decrease scan rate and raise
processing capabilities of the system.

3.2.2. Force shoes

Force sensors like Force Sensitive Resistors (FSR) are arranged in the sole of shoes in
such a way that the distributed foot pressure can be measured.23,32,33 As the GRF begins
at the point of heel contact and ends at the point near toe, force shoes could provide a
good dataset for gait analysis.24 At this context, FSR sensors may not be enough to
measure tri-axial force and moment information. Parallel force sensor technology
attached at heel and forefoot regions could provide reliable dataset for motion dynamic
analysis.34,35 Force Shoes data also need to be combined with limbs kinematic data for
understanding and characterizing human lo- comotion.23,28,35

3.2.3. Magnetic system

In this technique, ferromagnetic markers are used with the subject body. In the
experimented area, the magnetic fields generated by the magnetic system are distorted by
the markers and the distortion points are sensed by 3D sensors to analyze the movement
patterns of the markers which lead to the subject’s locomotion analysis.15 One of the
good advantages to use this technique is magnetic system does not affect if line-of-sight
difficulties occurs.38 6 DoF motion information can also be analyzed using this strategy.
On the other hand, magnetic system can easily be distorted by the magnetic materials
used within the volume of measurement.23,38’39’47 Moreover, the system response is
limited (30 Hz) which is below the required rate of data acquisition for high-fidelity
analysis.48 The system is not suitable to use and not recommended for gait analysis.

3.2.4. Acoustic tracking system

In this technique ultrasonic pulse technique is used to determine the positions of

movements. This technique supports both inside-out and outside-in technique depending
on the placement of the transmitter either with the subject body or fixed within the setup
area of analysis.15 Ultrasonic sensor uses the time taken in sending and receiving
reflected wave signals by applying the speed of sound flight through air.50 Measurement
range for this sensor system varies from 1.7 cm to ~ 450 cm. This system may not
provide accurate positional information because of noise and calculation complexities.
Moreover a clear line-of-sight is needed.15,51 The system could be useful if using at the
heel position to measure distance between floor and heel in detecting heel contact and off
moment while walking. In addition, this system could show its usefulness for bumpy or
nonuniform surface walking and ascending-descending stairs.52

3.3. Nonindependent system

3.3.1. Force plates mechanism

This technique consist of metal plates having load cell (most commonly) at each corner
of the plates. This mechanism is used to measure the GRF caused by standing or moving
subject of experiment.24,46 The shape of force plate can vary based on the design such as
square or triangular. Sensors (resistive, capacitive, or piezoelectric, piezoresistive, strain
gauge, etc.) used in force plate could also vary based on pressure range, sensitivity, and
linearity. Force plate mechanism provides the facility to measure the force induced on
the plate and its directions.49 As the force plates are placed on a fixed location on the
ground, the CoP of the subject body can easily be calculated but for a long track it may
leads to increase cost. Moreover, the suitable position of placing the footsteps on the
plate may not be followed properly which could lead to the wrong calculation of CoP
point. Data captured from foot plates should combine with limbs kinematics information
to analyze the principles of gait.
3.3.2. Electromyography

Electromyography (EMG) is used to measure the small electric signals produced by

muscles during contraction while walking or other locomotion.45 EMG has two types:
Surface EMG (sEMG) and Intramuscular EMG (iEMG). sEMG is much

easier to use compared with iEMG as the first one uses electrodes on the skin and the
second one uses fine wires inserted into the deep muscle.24,45,53 But sEMG produce less
efficient electric signals than iEMG. There are two types of sEMG: passive and active.
Active sEMG provides signal amplification at the electrode side that reduces signal
noise.31 As the musculoskeletal muscles have the responsibility to produce movements of
the skeletal system in order to maintain the locomotion, EMG signal could lead in the
field of locomotion and gait analysis if combining with other system responses.

4.3.3. Electroencephalography

Human brain performs most complex and complicated jobs in controlling the harmony of
human gait. So it is important to study on the behavior pattern of brain signals and
correlation with muscle functions relating to various actions of gait activity.54
Technology that involves in brain computer interfacing depends on the acquisition, data
processing, interpretation, and learning of brain electrical signals. In that case,
Electroencephalography (EEG) is captured using EEG cap with distributed electrodes.
Basically two types of electrodes are used, gelled and dry, where dry EEG cap is
designed with expectation to facilitate suitable acquisition of EEG signals.55 The purpose
of capturing EEG signal is to classify the signal patterns in Brain Neuron Computer
Interfacing (BNCI) to control mechanical arms involved in gait rehabilitation,
enhancement, and training.56,57 Monitoring EEG signals during robot assisted gait
training is also necessary because the training could impose negative effect in
rehabilitation if brain neural activities become idle for lack of cooperation or
stimulation.58

4.3.4. Medical imaging technique

Biomechanical modeling of human is not possible to accomplish without having

biomechanical parameters.45,59,60 The important parameters are: segment length, segment
mass, segment CoM, movement axis, muscle pull angle, segment density, moment of
inertia.61,62 In medical imaging technique, Computer Tomography (CT) scanning,
Magnetic Resonance Image (MRI), X-ray, molecular imaging, and ultrasound are
commonly used to facilitate anthropometric measurement by maintaining quality and
accuracy.63,64 These anatomical data are used to model the geometrical structure of
subject’s body. Kinetic and kinematic data are applied to the model for the analysis of
gait patterns and behavior.

Technologies Remarks Limitations

Motion capture . Comparatively easier . Need special setup for

to use. experiment with
camera2,20,21 . .
active line-of-site.
Popular system in gait
. . Faster locomotion
analysis.
. . needs faster sampling
Provides robust and rate.
. precise acquisition of .
High shutter speed
. physical movements .
causes the aperture
over virtual modeling.
. unable to adjust in
Reusability of captured low intensity of light.
image sequence.
View angle and
Allow to have detailed distance impose limits
information of the on capture volume
subject and and size. Marker-less
environment. Subject analysis presents
geometry and textures inaccuracy of interest
can be obtained point selections. Skin
accurately. movement artifacts

Sometimes little skill is over the skeletal

required in monitoring. structure shows

unexpected
disturbance in marker-
based system.

. Sometimes
uncomfortable
 because of marker
attachment with body.

Optoelectronic . Provides detailed . For quicker

system2,26,27,29 information of the movement accuracy
. .
subject geometry. decreases because of
. . sampling rate
Provides robust and
precise acquisition of (50Hz to 1kHz).
physical movements.
Problems with
Complex analysis
transparent and
strategy provides
reflective surface.
precise and more
measurement Sometimes expensive

capabilities. laboratory setup is

required.

Inertial . High sampling rate . Uncomfortable for

system24,28,42–44 (100Hz to subjects as the
. .
sensors need to
10kHz)
. . attach with body.
Tri-axial data
. . Actual data
measurement measurement could
. capabilities enable to .
be interrupted
. do 3D analysis. . because of skin
Sensors are small, movement artifacts.
.
light weight, and cost
Sometimes difficult
effective.
to identify exact
Output signals can be length of segment
recorded and rotational axis.
immediately for
 processing. Different positions
Monitoring of gait of sensor
properties during attachments show
daily activities. variations in
acceleration
No need of
sensing.
controlled
environment and Limited battery
supports to use in duration. Complex
any place. Active strategy is needed in
role of patient can be estimating gait
monitored. parameters.

Electrogoniometer . Normally . Single plane

inexpensive. Output angular movement.
(EGM)2,15,24 . .
signals can be used
Uncomfortable to
. for immediate .
wear.
. recording and .
computation. Difficult to fit with
. . joint axis having
Planner movement
. two or more DoF.
information can be
recorded . Does not show good
independently. quality result for

Generally the system lower limbs.

does not need Provides limited

complex processing number of gait
algorithms. parameters.

Output signals Need external

(voltages) are power.
proportional to
Relative angular
angular
information is
displacement,
provided.
i.e., linear.
Force plates . No direct attachment . Fixed with ground.
mechanism24,46,49 with subject body.
. . Needs to combine
Used to calculate with limb
. .
GRF. kinematics for gait
analysis.
CoP can be
calculated easily. Foot contact
sometimes
misplaced.

. Suitable for
laboratory setting
only.

Gait mat or . Nonactive . Finite size of

pressure attachment with sensors provides
. .
subject body. variations in
mat19,30,31
. . resolutions.
Portable and low
. cost. Good dataset Increased resolution
for foot contact, decreases system
distributed pressure, scan rate.
and GRF.
Needs to combine
CoP can easily be with limbs
calculated. kinematics.

. Suitable only for

laboratory setting.

Force . Active attachment of . Limbs kinematic

sensors with shoes data are needed to
shoes23,24,28,34– . .
facilitates to use combine with the
37
. anywhere. . system. Sometimes

Distributed pressure uncomfortable.

 . measurement. . Difficulties in
Distributed sensor proper positioning
. .
locations allow for nondistributed
fitting with large arrangement. Slow
range of foot sizes. response will lead
Provides GRF data to wrong
sets. interpretation.

CoP can be Less effective for

determined by using bumpy or uneven
limbs kinematic surface and
information. stepping up-down
stairs.

Systems Applied techniques Features Comments

3-D Gait23 (Dr. . Marker-based system . Can be used both . Placing 20

Reed Ferber, for Walking and small markers
. (20 to 30 small . .
Running Running gait to subject’s
(9.5mm) retroreflective
. . analysis. . lower limbs
Injury Clinic, markers). Uses Vicon
University of . camera system (3 to 8 . Measures 3D . take about

cameras). Treadmill- . movement patterns 20min.

Calgary, CA)
based walking or for pelvis, hip, Markers need
.
running. Custom- knee, and ankle. to be placed
designed software for very carefully
Supported
data processing and and accurately
movements for
analysis. to capture
lower limbs are:
accurate
flexion extension,
information.
abduction–
adduction, and Need complex
rotation. Large algorithm for
database with 3D
gait biomechanical
 information. data
Provides 3D gait extraction.
biomechanical
Costly.
report to identify
root causes of
musculoskeletal
injuries. Data
collection time:
about 40s jogging
or walking on
treadmill.

PediGait (Pedi . Four cameras and a . Filming and . No kinematic

laptop. recording gait or dynamic
Technology (PT) . . .
activities from four information
Treadmill-based
Inc.) . . viewpoints, front, . are provided.
walking or running.
back, left, and right. Not an
Custom design
advanced
PediGait Software. Video can be
system.
slowed down or can
be analyzed frame Very simple
by frame. and low cost.

Comparisons
between multiple
videos.

Xsens Out- . Inertial sensor . Full-body motion . Comparatively

technology. analysis system. complex
Walk44,70,71,214 . . .
strategy is
Wireless Uses 17 inertial
(Xsens North . . . needed.
transmission of motion trackers.
America Inc.) . Limited
data. Custom design
Each sensor is light battery
Xsens Software. . weight
lifetime.
 (38g) and small in Anatomical
size (39 54 landmarks
28mm). dislocation
mostly affects
Provides highly
the offset of
accurate joint
segment axial
angles and motion
rotations.
trajectories.

Can be used for all

kind of motion
analysis.

iSen (STT . Uses STT’s inertial . Capture 3D motion . Data

Systems, sensors. data. Uses 2 to 14 processing
. . .
sensors depending needs a
Spain) Uses Bluetooth
. . on purpose of use. . complex
protocol to store data.
iSen custom design . Easy to setup. algorithm.
Battery
software. Possible to use for
lifetime is
any kind of motion
limited.
or gait analysis.
Sensor
dislocation
will produce
unexpected
results.
Walkway . A walkway system . Provides . Only
system for gait analysis. informatio footsteps
. . .
Pressure mapping n on force and planter
(Tekscan, Inc.,
. strategy. . and plantar . pressure can
USA)
. System consists of . pressure, . be
temporal and measured.
scanning electronics, .
distance
custom designed No
parameters,
software, and thin- kinematic or
velocity and
film sensors. Sensor dynamic
cadence for gait
resolutions: (a) information
analysis.
standard resolution for limbs or
Captures accurate
(1.4 sensels per cm2) joints
kinetic, timing,
and (b) high movements.
and physical
Length of
resolution (4 sensel measurements.
walkway
per cm2).
A platform for will
foot functional increase
analysis using total cost.
multiple
Finite size
sequential
of sensors
footsteps.
provides
Provides toe-in variations in
and toe-out angle resolutions.
information
comparing line of
progression.

Useful for
pediatric analysis.
 . Increased
resolution
decreases
system scan
rate.

GAITRite215 . Instrumented gait . Measure spatial

((SMS mat with embedded and temporal gait
. .
pressure sensors. characteristics.
Technologies
. System comprises .
Provides
Ltd., UK) 18,432 pressure . automatic
sensors in active
footstep
measurement area
identification and
(61cm
parameter
wideand488cmlong).
calculations.
Sampling rate varies
between 32.2Hz and Supplies
quantitative
38.4Hz.
information about
patient’s gait.

Useful for
pediatric analysis.

OptoGait/Opto- . Optical . System displays . Kinematic

measurement. real-time step information
Jump216 . . .
System comprises a length, gait cycle, and joint
(GoSports . series of transmitter . gait rhythm, gait . motion
Technologies,
. and receiver units . print, speed and . trajectories
Atlanta) acceleration cannot be
. (springboards). .
calculations for obtained.
. Can be placed up to each individual
Not useful
3m apart and parallel stride.
for full
to each other.
body
 Each unit (1m) Can be used in motion
consistsof32 LEDs various types of analysis.
places high as 3mm gaits including
Not useful
from ground level walking, running,
for lower
with and jumping.
limbs
31.115mm intervals. Setup can easily kinematic
System needs custom be adopted on the analysis.
designed OptoJump floor, sports Long track
orOptoWalksoftware. environment, as will
Complex module well as with increase the
uses high speed treadmill. cost and
cameras with processing
Possible to
springboards unit. capabilities.
measure flight
time and contact
time during the
performance of a
series of jumps.
Applicable for
clinical, sports,
and research
purpose.

5. Characterization of Human Walking

5.1. Phases of walking

The characteristics of human walking can be defined as the alternation of the same type
of elementary movements of legs and feet. The movements of the legs for a single step
can be categorized into two phases: Double Support Phase (DSP) and Single Support
Phase (SSP).72,73 DSP starts at the moment of heel-contact or heelstrike of one foot on the
ground and ends at the toe-off situation of the rear foot. The end of DSP is the starting of
SSP or swing phase. The conclusion of swing phase occurs at the beginning of DSP i.e.,
heel-strike.74 So, a cycle of a single step begins with the heel-strike (0% of the gait cycle)
and ends up with the following heel-strike (100% of the gait cycle) of the same foot. A
gait cycle of a single leg also can be characterized by two other phases: Stance Phase and
Swing Phase.75 The Swing Phase and the SSP represent the same manner of the
movement pattern and occurs during 40% (approximately) of a gait cycle. The rest 60%
(approximately) of a gait cycle represents the Stance Phase of the same foot.74,76,77,80
During Stance Phase, DSP occurs at the beginning and the end of the phase. It lasts
almost 10–12% (approximately) of a gait cycle for comparatively slow walking.77–79 For
increasing walking speed, the percentage of DSP decreases and almost disappears while
running. In between the two DSPs, Load Response (LRs) and Mid Stance (MSt) situation
occur for the responsible foot while the other foot reflects the swing mode.

Study on gait analysis is required to design apposite walking model and to analyze the
impact of disturbances on the gait pattern.81 To categorize the functionality of different
movements of joints and limbs of lower extremity of human body, walking gait pattern is
possible to analyze by eight different sub-phases based on the foot contact with the
ground, as mentioned by Tao et al.82 These sub-phases are, Initial contact (ICt), LRs,
MSt, Terminal Stance (TSt), Pre-swing (PSw), Initial Swing (ISw), Mid-swing (MSw),
and Terminal Swing (TSw). Each single step of walking enables the propulsion of body
to move forward. This propulsion is ensured by three stages of the lower limbs: (a) body
weight transition, (b) balancing on single limb, and (c) advancement of limb.82 Cao et al.
presented that a gait cycle also can be adapted by four different stages: contact stage,
support stage, leaving stage, and swing stage.83–85 Although a little variation is observed
in gait characteristics among nondisable young people, older people, and people with
different heights; the basic pattern of walking gait is same.86–91 In normal condition, the
average comfortable speed of walking is approximately 2.2km to 2.8km per hour,
average stride length is about 70cm to 82cm, average stride width is 7cm to 9cm, average
steps 90 to 120per min, and average gait cycle is 0.8s to 1.2s.86

Figure 1 represents eight different poses of a gait cycle for comparatively slow walking.
In this representation a gait cycle is split into two main phases: stance phase and swing
phase where stance phase has six sub-phases and swing phase has four sub-phases.
According to Fig. 1, there exist two different circles, inner circle and outer circle. Inner
one represents right leg movement cycle and outer circle
Fig. 1. Representation of eight different poses of a gait cycle and its time dimension for
comparatively slow walking characteristics.

presents left leg movement cycle. Each circle consists of two interconnected arrows
reflecting two major phases. Longer arrow exemplifies stance phase and smaller arrow
illustrates swing phase. Considering the cycle as 100%, stance phase occupies almost
62% starting from the beginning of the cycle. The movement cycles of both legs do not
start at the same time. There is a delay almost 50% of the total gait cycle. Figure 1 shows
the outer circle (left leg movement cycle) starts at the bottom (0% position) of the figure
and inner circle (right leg movement cycle) begins almost after 50% of the outer one, as
indicated at the top (0%) position of the inner circle. Swing phase occupies about 40% of
the total gait cycle.

Figure 1 also represents four regions indicating two SSPs and DSPs. Though SSP is the
reflection of swing phase, it occurs two times in a single gait cycle and occupies almost
80% (40% þ 40%) of total cycle. Similarly, DSP also happens for two times and
continues for 20% (10% þ 10%) approximately.
Stance phase is one of the major parts of a gait cycle because during this time body is
balanced on single leg, contact limb supports total weight, body propelled forward, and
also maintains the direction of swing leg movement. During this time

Table 3. Primary activities of lower limb muscles during a gait cycle.86

Primary activity group Involved muscles

Shock absorbers (during weight Quadriceps, dorsiflexors.

loading)

Stabilizers (during stance Gluteal muscle group, tensor fascia lata,

phase) erector spinae.

Foot lift off (while weight Flexor digitorum longus, flexor hallucis
unloading) longus, gastrocnemius, peroneus longus
and brevis, soleus, tibialis posterior.

Accelerators (during weight Adductor longus and magnus, iliopsoas,

unloading) sartorius.

Foot controllers (during swing Extensor digitorum longus, extensor

phase) hallucis longus, tibialis anterior.

Decelerators (during swing Gracilis, semimembranosus,

phase, MSw to semitendinosus, biceps femoris.

TSw.)

five muscles are active to prevent crumpling of the support limb. For unimpaired
ambulation, main active muscles are: Gastrocnemius and soleus (Function: MSt to heel
strike), gluteus maximus (Function: heel strike to MSt), gluteus medius and gluteus
minimus (Function: heel strike to toe off), hamstrings (Function: MSw to heel strike),
iliopsoas and adductors (Function: toe off to MSw), quadriceps (Function: heel strike to
mid-stance and toe off to MSw), tibialis anterior and peroneals (Function: heel strike to
foot flat and toe off to heel strike).86 Table 3 represents primary activities of muscles
involved in performing walking gait.

Stance phase accumulates six sub-phases named as, Heel Contact (HCtL for left heel
contact and HCtR for right heel contact and so on), Foot Landing (FLn), LRs, MSt, TSt,
and Toe Off (TOf). On the other hand, Swing Phase is the collection of four different
sub-phases: PSw, ISw, MSw, and TSw. The two transition points of both phases are
represented by two separate poses, but named based on the described phase. For
example, TSwL is the end of swing phase for left foot, which is the starting point of the
stance phase, HCtL, of the same foot, and represented by the single pose shown at the
lower side of Fig. 1. Again the same pose reflects a different stage of right foot
movement cycle, which is defined as TStR. Similarly, TOfL and PSwL are the terminating
and beginning point of left foot stance and swing phases represented by a single pose.
This pose also indicates Foot Landing pose (FLnR) of right foot movement cycle. This
situation can be explained from either side depending on the interested movement cycle
of left foot or right foot. Another interesting point is that a single pose cannot reflect
same state for both the foot. If so, the state will describe idle stance phase of the subject.

Considering the left foot movement pattern, the stance phase begins with the HCtL and
ends up with TOfL. The ICt or HCtL occurs at the contact moment between heel and the
walking surface while foot is almost 20 from the horizontal condition.93,94 In this event,
energy is consumed because of shock absorption at heel strike. During this time the rear
foot shows Transition Stance (TStR) characteristics. This HCt phase is also the beginning
of first DSP of a gait cycle.

Foot Landing (FLnL) phase is the second sub-phase of a gait cycle. After HCtL phase,
foot plantarflex rapidly to flat foot condition. This phase is responsible to move body
forward and also describes the load exchanging situation from rear foot to front foot.
During this phase the rear foot presents the transition between stance (TOfR) and swing
(PSwR) mode. First DSP also ended up at this phase and starts first SSP of the gait cycle.

Load Response (LRsL) phase begins with full contact of foot. In this condition, energy is
consumed again because of body balance, push off, and body propulsion. The rear leg
presents Initial Swing (ISwR) phase with hip flexion, knee flexion, and ankle begins
dorsiflexion.

During Mid Stance (MStL) phase, the leg is responsible to support the total body weight.
At this phase body is about to align over the forefoot. The rear limb advances
overthestationarylegwithankledorsiflexionreflectingMidSwing(MSwR)phase.In this
condition, knee and hip of swing limb extend and flex, respectively.
Transition Stance (TStL) completes the first SSP and begins the second DSP of the gait
cycle. In this condition, the advancement of swing leg stops with heel strike and
stationary leg comes at the rear position. Body moves forward and the ankle dorsiflexion
occur for the rear foot. Heel of the rear foot begins lifting up at this moment. This phase
also describes the transition state in between TSwR and HCtR phase of the swing leg.

Toe Off (TOfL) phase is the end of second DSP as well as the end of stance phase of the
gait cycle. This is the starting of Pre Swing (PSwL) phase of that foot. At this interval the
rear leg shows ankle planter flexion, knee flexion, and hip extension and maintains the
push off action to propel body forward. The opposite leg represents Foot Landing (FLnR)
phase as the preparation to support full body weight.

Initial swing (ISwL) describes the leg with hip flexion, increasing knee flexion, and ankle
dorsiflexion. In this mode the foot is lifted up and the limb begins to swing forward with
acceleration. Opposite leg reflects the Load Response (LRsR) characteristics.

The next sub-phase is Mid Swing (MSwL) phase that describes continuation of hip
flexion, knee extension, and ankle dorsiflexion. The swing leg advances and body mass
moves over the stance foot. The opposite limb shows Mid Stance (MStR) characteristics
during this time.

The final sub-phase of a gait cycle is the termination of swing phase named as Terminal
swing (TSwL). This is also the beginning of the next cycle of walking gait. This phase
starts when tibia is at almost in vertical position and ends up with deacceleration of foot
and strike on the floor. In this phase limb progression is completed with extension of
knee joint. The hip maintains its flexion position and ankle remains dorsiflexed. The
other leg demonstrates Terminal Stance (TStR) phase.

5.2. CoP-CoM movement patterns

CoM and CoP movement trajectories are also important points to consider explaining the
behavior of walking gait. CoM of human body is located at midpoint of hip joint line and
at the anterior to the second Sacral vertebra. During walking,
Fig. 2. CoM and CoP movement characteristics of human body for walking, indicating
HCt and TOf moments with the representation of gait cycles based on left or right foot.
Gait cycle is divided into phases and sub-phases.

CoM of body diverges from the straight line of movement direction in lateral and vertical
sinusoidal displacement. Figure 2 represents the sinusoidal movement of CoM while
subject walking on straight line. For both cases of lateral and vertical sinusoidal
behaviors, the average displacement is almost 5cm for adult male.86 During MSt phase
CoM reaches at the height point and lateral limits. Lowest point of CoM vertical
deviation occurs during DSP. The important factor is that, CoM never cross the baseline
of foot (CoP on foot print) as presented in Fig. 2.

CoM forwards from one foot to other foot in the first half of stance with deacceleration
and at the second half of stance phase CoM continues with medial acceleration towards
the next position of the swing foot. The challenging part of the movement is that human
body is never more than 400ms (approximately) away from falling that describes the
trajectory of swing foot to decide its next position.92 For walking in a constant speed,
CoM always stays either side of the direction line for 50% of a gait cycle. For every half
of a cycle CoM crosses the center line. Every HCt occurs around the moment of this
crossing time. Figure 2 illustrates the CoM and CoP movement characteristics for a
walking gait with indication of HCt and TOf moments. The figure also represents a gait
cycle with respect to left or right foot divided and sub divided into several phases.

5.3. Initiation and termination of gait

Initiation and termination of walking gait are also critical. For both the cases human have
to perform half step in different manner, Quiet Standing phase to continuous cycle for
initiation and vice versa for termination. At the initiation of walking, it requires two steps
(half step and a continuous step) to comply with the steady state CoP-CoM tracking
pattern,94 shown in Fig. 2. GI starts with the decupling of the CoM and CoP which
induced forward acceleration of CoM towards stance leg.95,96 At this moment swing leg
toe push off occurs and CoP moves a little bit backward to stance foot and continues
towards pre-determined heel contact point.97–99 GI ends up at the point of heel contact of
the swing foot which is the starting of the steadystate gait cycle.

Transition from continuous gait to quiet standing pose is considered as GT.100 This
characteristic explains the reduction of swing foot push-off, increased braking force of
the stance foot, and deceleration of CoM during the final step.101–105 It is important to
know that the GT strategy may differ depending on the velocity and speed of walking,
and instant or planned termination.100,106,107 Rapid change of CoM such as, redirection
and deceleration, may cause injury.108 Therefore, stance limb has the main responsibility
to produce the necessary breaking force in controlled way so that CoM and CoP becomes
stable and maintains the quiet standing posture.109 GT also needs two steps to complete
the task.110 Ryckewaert et al. represents the GT with three phases.110 Firstly, CoP moves
forward than CoM and stays at the contact surface of the stance foot. At this condition
GRF cause the sagittal breaking process. Secondly, lateral shift of CoP occurs correlating
with the breaking force. Thirdly, the adjustment of CoM and CoP position ensures in
reaching quiet standing pose.

5.4. Ground reaction force

Impact force transmission of human body lower limbs is important to analyze to find out
the condition of catastrophic failure or damages during walking. At this point the impact
force can be defined as the force that occurs at the contact moment between heel and
ground.105,111,112 Figure 3(a) shows three stages of stance phase of left limb with three
components of induced GRF: Vertical GRF (VGRF), Anteroposterior GRF (AGRF,
PGRF), and Mediolateral GRF (MGRF, LGRF). GRF is considered as the equal and
opposite of the force that applied by foot on the ground during locomotion.113 As GRF is
the external force acting on the body while walking, it is important to study in gait
analysis.

The behavior of VGRF while walking in moderate speed is represented in

Fig. 3(b). VGRF can be calculated based on Newtonian Law as presented in Eq. (1),114
where the net force is expressed as the vector summation of GRF and

Fig. 3. (a) Left limb stance phase with three components of induced GRF: Vertical GFR
(VGRF), Anteroposterior GRF (AGRF, PGRF), and Mediolateral GRF (MGRF,
LGRF),119 (b), (c), and (d) represent the characteristics of VGRF in z-direction,
horizontal components of GRF (A-P GRF) in x-direction, and Mediolateral component
of GRF (M-L GRF) in y-direction.121

2.5 Review of Instrumentation Gait Analysis

Orthopedic surgery and prosthesis design both require lots of knowledge of human
movement. The data from studies, especially gait analysis, is a very important reference
to improve the comfort and performance (e.g. maximum walking velocity) of the
prosthesis.

2.6 Selection of Sensors

For gait measurements that are based on the force exerted by the body to the ground,
Rueterbories et al. point out that “the only possible position for the sensors is therefore
between the sole of the foot and the ground”, the sensors are transducers which can be
“mechanical, load dependent switches, capacitive or piezoelectric elements”

2.7 Force Sensor Review

For robotic sensing, mainly two types of sensors are used: internal state sensors and
external state sensors. External state sensors are “used to monitor the geometric and/or
dynamic relation between robot and its task, environment, or the object that is handling.
[22]” The most commonly used force sensors are made of piezoelectrical materials, the
theory will be discussed in the following subsection. A sensor utilizing applying
piezoelectricity can be extremely thin and sensitive.

2.7.1 Theoretical Background

Jacques and Pierre Curie discovered an special effect applying mechanical forces on
certain type of crystal, the crystal became polarized electrically, and generated voltages
of the opposite polarity proportional to the applied force. This effect was called the
piezoelectric effect. Since then, piezoelectric materials have been commonly used in the
power supplies [23], electrical measurement (microelectromechanical systems [24]),
sensors (piezoresistive force sensors[25]), motors[26], frequency standards [27], etc.

In classical piezoelectricity, the anisotropic resistivity tensor p can be expressed as in

equation (1) in terms of stress vector (ff), piezoresistive tensor (n), elasticity tensor (D),
and strain vector (e)[25].

P Po{Jm + n 6} — Po{Jm + nD£] (1)

Where 6 = De.

From equation(1), the resistivity tensor is determined by the material stresses value.

E = p] (2)

E = -70 (3)

Solving the simultaneous equations (2) and (3), the electric potential 0 (corresponding to
the electric field) and resistivity tensor p (the mechanical stress applied on the material)
can be related, therefore by measuring the electric potential we can measure the
anisotropic resistivity tensor and based upon the known properties of the material we can
compute the force vector.

2.7.3 Structure of a Piezoelectric Sensor

Piezoresistivity is commonly used in electronic measurements utilizing piezoelectric

quartz crystals. A change in the mechanical stress on the crystal causes a change in the
material’s resistivity, which can be measured by applying and electrical potential and
then using Ohm’s Law [28].

A charge-collection electrode is located between two crystal materials. The housing

provides the other electrode. The voltage generated by the compressed quartz is used to
sense the force applied to the quartz. When applying a vertical force on the impact cap of
the Figure 2. The double-layer quartz structure will generate an electric potential between
the electrodes and this voltage will be routed to an amplifier. The stud preloads are used
to provide a stable initial state for the sensor by assure close contact of all parts.

Similarly piezoelectric materials can also be used to create a torque sensor. Figure 3 and
Figure 4 show an example of a force/torque sensor [30] which is able to measure
horizontal forces as well as the vertical force by solving the earlier simultaneous
equations for all four sensors.

Figure r: Structure of a force sensor

1. Frontal cover, 2. Piezoelectric quartz crystal, 3.load distribution ring 4. Inner wall, 5. Preload
bolt, 6.
Figure f: Torque sensor