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Motion analysis laboratory and evidence-based medicine

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  • Motion analysis laboratory and evidence-based medicine

    I would like to know if researchers who attended in 2018 GCMAS Conference (Research Council) could present their views on the diffusion of 3d motion analysis and a possible limitation on the principles of evidence-based medicine in motor rehabilitation processes.

    << GCMAS 2018 - Research Council Gait/motion analysis is underutilized due to the lack of understanding by clinicians of its benefits and limitations. (6.6, SD 2.0)
    A major barrier to a wider use of gait/motion analysis for directing interventions or in outcome assessment is the lack of a basic understanding by physicians, therapists, orthotists/prosthetists, and other medical professionals regarding its capabilities, benefits, and limitations. The purposes of this line of research are to develop and implement educational methods that can assist medical professionals in understanding the concepts involved in gait/motion analysis.

    Gait/motion analysis is a cost effective patient management tool. (6.4, SD 2.1)
    The cost effectiveness of gait analysis as a clinically useful tool has yet to be demonstrated as it relates to an individual’s participation, functional limitations, and disability. The lack of information has impeded the ability to justify the benefits of gait analysis to the consumer, medical community, and insurance providers. The purpose of this line of research is to demonstrate the cost effectiveness of gait/motion analysis as a patient management tool.>>

    I apologize for the translation failures.
    Thank you very much for your attention.

  • #2
    Re: Motion analysis laboratory and evidence-based medicine

    Hi Wagner,

    I think you bring up excellent questions.

    In my experience, one of the main barriers, perhaps even greater than awareness & understanding of mocap in clinicians, is most mocap systems are not designed for clinical use. Seldom do clinicians have more than 20-30 minutes with a patient.

    If there is a combination of long setup time, complicated operations, and/or post-processing and manual digesting of information, the clinician will not be able to practically use the system in the clinical context.

    For lightning fast elite athletes dynamic movements, or complex patient population groups who have access to biomechanics-grade motion capture labs, high fidelity high framerate recording is pretty amazing! For most clinical contexts, the research grade application is tough to apply in clinical context.

    I am a technologist and co-founder of EuMotus ( - we design and provide motion analysis for physical therapy clinics.


    • #3
      Re: Motion analysis laboratory and evidence-based medicine


      I have not attended a CGMAS meeting but have previously conducted clinical 3DMA marker based gait assessments for CP children over a number of years. I also have a keen interest in improving the validity and reliability of gait analysis methods and clinical application.

      I have found clinicians (orthopedic surgeons, therapists, physiotherapist) working with CP children more than capable of understanding gait data presented to them (joint angles, joint powers, EMG, passive ROM, joint strength). These clinicians have been supportive of 3D analysis as it helped their understanding of gait and in decision making. Expectedly, with time the clinicians and my own ability to interpret the meaning of the data has improved, including identifying the generation of moment, presence and types of muscle contracture and identifying limitations to movement.

      In my experience the barrier is not the clinicians and I do not feel it is the clinicians that are the ones that need to know the technical aspects of 3D Gait assessment. It is the job of the motion analysis expert to know the strengths, weaknesses, limitations, validity, best practices etc. of the methods they use and to ensure the validity and reliability of the data they present. My view is that one barrier to wider clinical use of 3DMA (along with expense) is the lack of basic understanding of 3DMA methods by the motion analysis expert and this is where the education needs to be directed. I feel that if you present a reliable and accurate tool, that has direct benefits in identifying the generation and limitations of movement as well as can quantify changes in gait over time, then there will be a greater uptake of clinical 3DMA gait assessment. The caveat being that is it not overly expensive per assessment.

      To conduct a gait assessment is it not a cost efficient exercise. The gait assessment itself is relatively quick taking 45-50mins. Including EMG may extend this out to 75-80mins. There is ½ hour set up time and the $250,000+ of motion analysis equipment adds a chunk of depreciation to the costs. However it is the hours of post processing and data analysis that significantly adds to the end cost. I have found a major barrier to continuing clinical gait analysis was funding and who was willing to pay for it? Is it cost effective? Until there is validity and reliability in gait data along with the ability to understand and interpret the data across labs conducting clinical 3DMA (reduced post processing and equipment costs would also help) then clinical 3D gait analysis is not a cost effective exercise either.

      Also interested in other views out there on clinical 3DMA


      • #4
        Re: Motion analysis laboratory and evidence-based medicine

        Dear Dr. Doynov and Dr. Carman,

        Thank you very much for your attention.

        Perhaps my view is simplistic because it is based on industrial engineering. I have difficulty understanding how the evaluation of any procedure based on the scientific method can prescind of instrumentation for measuring the variables involved.
        I believe that the process of rehabilitation of the musculoskeletal system could be divided into 2 steps: evaluation of functionality in specific tasks, such as gait (kinematics, kinetics and muscle activity measurement - gait analysis), and clinical procedures for correction (surgical and physical therapy planning).

        Gait analysis has some important intrinsic limitations, such as a mandatory noninvasive examination, and all the technical artifacts that this limitation imposes on the results. This condition should justify the inclusion of instrumented motion analysis in undergraduate courses, so errors in applying exam protocols or evaluating results could be minimized - also, more researchers could be interested in biomechanics for the development of new technologies and procedures. On the other hand, what are the scientific method-based alternatives to 3d motion analysis, even with their limitations?

        Clinical conclusions may be more complex, such as reproducing the results of gait analysis to surgical procedures (eg, bone rotational corrections), however, a critical aspect is predicting the results of medium or long-term surgical interventions, especially if neurological variables, as spasticity, exist. These questions would require another instrumentation set to measure so many variables (maybe software like OpenSim could be an additional tool to support future clinical decisions).

        About the costs of each clinical examination or medical treatment, I think it is the responsibility of each society to define how to finance the health system and other social services.
        As mentioned, these considerations are simplistic - this was the reason for the initial post.

        Thank you again.
        Best Regards


        • #5
          Re: Motion analysis laboratory and evidence-based medicine

          I think that Allan Carman’s reply, “one barrier to wider clinical use of 3DMA (along with expense) is the lack of basic understanding of 3DMA methods by the motion analysis expert and this is where the education needs to be directed” - defines the missing factor in basic medical education, I know through conversations with my own GP that I have a far better understanding of CMA than she does and I definitely don't consider myself an expert, I just work with people in the field.

          Many years ago in the 80's, I was installing Vicon motion capture systems and working with the Helen Hayes Hospital lab to install the Helen Hayes Software for many of the systems and get each lab up and running, generating graphs that could often be printed as soon as the patient left the lab - but then everyone had to sit down and write the report and evaluation for the physicians. That was always the area the our customers pleaded with us to address - the difficulty is assessing and interpreting all of the data. The Vicon Clinical Manager software was built in an attempt to start addressing this and while it was very successful at selling more Vicon systems, the issue of interpreting the results was abandoned, together with clinical software, after a few years as movie animation because a bigger sales factor.

          No manufacturer is going to address this problem because it's not a significant factor in selling more systems - I think that the solution has to either come from users working together, independently of the motion capture industry; or from a national organization like the NIH that sees this as issue that affects the population. There was a project, back in the very early days of AI, that was going to automate the interpretation of motion lab data but I don't know what happened to it, I think it failed to get funded.


          • #6
            Re: Motion analysis laboratory and evidence-based medicine

            Hello all,

            As a physical therapist (and a biomechanist), it seems to me that the problem (in the US at least) has always been with reimbursement. There are many medical tests which are quite profitable, but even though gait analysis has been around for more than 30 years, no one has ever found a way to make it cost effective or profitable. In the US, insurance companies have always seemed determined to pay for less, not more. I don't see them opening them pocket book for gait evals anytime soon. I think the future of gait analysis is not in the FULL traditional gait eval, but providing small pieces of a gait eval which can be done easily in a physical therapy or an MD clinic setting. You are seeing a lot of interest in the footpods (Garmin et al) especially in physical therapists who treat runners. I think breaking up the parts of the gait eval (EMG, joint kinematics, etc.) which can be done easily in the clinic without the assistance of an engineer is the future. An additional future of gait evals is through private pay. You are seeing this with the labs that evaluate running form and golf swing. I know that helping someone improve their golf swing is not as satisfying as helping a child with cerebral palsy walk but there it is. I know we all love the $500,000 gait analysis lab, but I think we need to find a way to take the show on the road and piecemeal it out to make it more feasible to take place in the clinic. That is my two cents. Thank you for starting the conversation Wagner!


            • #7
              Re: Motion analysis laboratory and evidence-based medicine

              Thank you very much for the additional posts.
              I apologize for my communication difficulties in English - however, I would like to add a few remarks.

              - I have difficulty understanding the absence of motion analysis instrumentation (kinematics, kinetics and electromyography) in undergraduate kinesiology and biomechanics disciplines. Perhaps an essential assignment of undergraduate courses is to develop critical analysis in students, and access to laboratories used in professional practice is a necessary resource for this purpose.
              Maybe the cost of equipment is a limitation - I requested some recent quotes and a motion capture system with 6 IR cameras of 2.2MP and biomechanics softwares, 1 force plate (load capacity 2000 lb) and 10-channel dynamic electromyography cost approximately US$ 70,000.

              -As Mr. Cramp mentioned, perhaps the NIH could contribute to the dissemination of "kinesiology and biomechanical laboratories" for teaching purposes with the contribution of societies such as GCMAS and ESMAC. Treatments of aging diseases, as hip and knee osteoarthritis, can be improved with the support of motion analysis.

              -In Brazil, a few private physiotherapy clinics are following the same segmented examination model (eg treadmill running and scapular dyskinesis) as described by Dr. Ann Tuzson. These are important personal initiatives, but unfortunately the structural problem in undergraduate courses still remains: academic background in the use of motion analysis systems.

              -Perhaps broader cost analysis should be done to justify the costs of motion analysis exams and reimbursement for insurance companies. The cost of a motion analysis examination should also be calculated by changes in the subsequent procedures of the rehabilitation process. Some references are in the link below:

              In my personal experience nothing will change in Brazil, but maybe other people have succeeded in this task.

              Thank you very much again for your attention and patience.
              Best Regards,


              • #8
                Re: Motion analysis laboratory and evidence-based medicine

                Dr. Robyn Grote's contribution to this topic:
                Spinal Life Australia

                "Following from the Wagner de Godoy question raised on biomechl I provide some comments from my experience, here in Australia, & draw from my The Winston Churchill Memorial Trust Australia Fellowship , 3DGA is the gold standard to assist treatment planning in the paediatric cohort, in particular, for cerebralpalsy, however Australia has been slower to adapt the use in the adults - perhaps due to insufficient engagement by labs with relevant health personnel, education or promotion. Following my Fellowship, it is likely that stand-alone gaitlabs will be surpassed by facilities that can analyse as well as provide treatment in a virtual environment e.g CAREN and other equipment from Motek and Hocoma. These facilities require less area & enable early #rehabilitation with immediate quantifiable feedback in trauma or acquired conditions affecting walking and movement."
                Last edited by Wagner De Godoy; August 12, 2019, 09:29 AM. Reason: spell check


                • #9
                  Re: Motion analysis laboratory and evidence-based medicine

                  Hi Wagner,

                  Ann here again. Why would you do it in a virtual environment? Why wouldn't you make technology that allows real time feedback in a real world environment? To date, I have not been sold on the use of virtual reality in rehabilitation. I am open to it, but I am afraid I don't really get it. Given my druthers, I would rather take my patient out into the real world and bring the motion lab with me. Shouldn't I be able to go out in the field with a laptop and get real time feedback? Thank you again for starting the conversation. -Ann


                  • #10
                    Re: Motion analysis laboratory and evidence-based medicine

                    last remarks:

                    I think there is a major discrepancy in the times between clinical motion analysis technology and the academic education of professionals in undergraduate courses (medicine, physiotherapy and engineering):
                    - The classic configuration of a clinical motion analysis system is old (6 IR cameras, 10-channel electromyography and force plates). I started working in a gait laboratory in Brazil in 1997.
                    - Undergraduate courses did not incorporate this technology as a basic resource for applied kinesiology study.
                    Perhaps the cost of equipment was the main constraint for universities, but some companies and researchers have provided systems that could make kinesiology labs viable over the past 10 years
                    Innovision Inc. and Motion Analysis Products
                    OptiTrak Flex3
                    KA video (I think this software was discontinued because Dr.Robert Schleihauf passed away a few years ago)
                    and the new technology based on 3d cameras (markerless systems) and IMMU systems.

                    Also, evaluating the purchase of remanufactured equipment would be an important option, if the university approves this type of acquisition.

                    Unfortunately, CGA laboratories are restricted to postgraduate courses and hospitals or rehabilitation centers specializing in surgical treatment of severe musculoskeletal disorders.

                    I think the best alternative for an educational laboratory is the cooperation between several departments of a university, because the basis of experimental kinesylogy is multidisciplinarity: physiotherapy, medicine, engineering, physics, mathematics and statistics, digital games and cinema are areas that could contribute to a shared laboratory (and cost sharing for a high-performance system: US$ 70,000: 6 IR cameras of 2.2Mp - High Speed camera with 300 fps at 2.2MP. Up to 10,000 fps -, 1 force plate 2000Lb, 16 EMG channels).

                    Maybe the future is in "old technology", but as a new academic perspective: cooperative work.

                    I apologize for the translation failures again.
                    Thank you very much for all the contributions to this thread.
                    Best Regards,
                    Last edited by Wagner De Godoy; September 22, 2019, 03:10 PM. Reason: web link rectification