Name: video movement analysis using smartphones (vimas): a pilot study
Uploaded: 2017-03-14T12:30:00
Description: Watch this Scientific Journal Video about Video Movement Analysis Using Smartphones ViMAS: A Pilot Study at JoVE.com

The authors wish to thank all the participants who generously gave their time to participate in this study.

This protocol was approved by the Institutional Review Board of Wayne State University.
1. Experimental Preparation
<ol>
	<li>Position cameras to capture the entire 6-m walkway. Use a total of 4 3D motion captures cameras to capture walking over a 6-m walkway.
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		<li>Place each of the cameras at the 4 corners of the 6 m walkway. Orient each of the cameras at the diagonal ends of the walkway to face each other.</li>
	</ol>
	</li>
	<li>Collect height, weight and leg length measures of eac...

<ol>
	<li>Brunnekreef, J. J., van Uden, C. J., van Moorsel, S., Kooloos, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+videotaped+observational+gait+analysis+in+patients+with+orthopedic+impairments.">Reliability of videotaped observational gait analysis in patients with orthopedic impairments.</a> BMC Musculoskelet Disord. 6 (17), (2005).</li><li>Jette, D. U., Halbert, J., Iverson, C., Miceli, E., Shah, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+standardized+outcome+measures+in+physical+therapist+practice:+perceptions+and+applications.">Use of standardized outcome measures in physical therapist practice: perceptions and applications.</a> Phys Ther. 89 (2), 125-135 (2009).</li><li>Jette, D. U., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evidence-based+practice:+beliefs,+attitudes,+knowledge,+and+behaviors+of+physical+therapists.">Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists.</a> Phys Ther. 83 (9), 786-805 (2003).</li><li>Stuberg, W. A., Colerick, V. L., Blanke, D. J., Bruce, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+a+Clinical+Gait+Analysis+Method+Using+Videography+and+Temporal-Distance+Measures+with+16-Mm+Cinematography.">Comparison of a Clinical Gait Analysis Method Using Videography and Temporal-Distance Measures with 16-Mm Cinematography.</a> Phys Ther. 68 (8), 1221-1225 (1988).</li><li>Norris, B. S., Olson, S. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concurrent+validity+and+reliability+of+two-dimensional+video+analysis+of+hip+and+knee+joint+motion+during+mechanical+lifting.">Concurrent validity and reliability of two-dimensional video analysis of hip and knee joint motion during mechanical lifting.</a> Physiother Theory Pract. 27 (7), 521-530 (2011).</li><li>Robinson, J. L., Smidt, G. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+gait+evaluation+in+the+clinic.">Quantitative gait evaluation in the clinic.</a> Phys Ther. 61 (3), 351-353 (1981).</li><li>Krystkowiak, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+abnormalities+induced+by+acquired+bilateral+pallidal+lesions:+a+motion+analysis+study.">Gait abnormalities induced by acquired bilateral pallidal lesions: a motion analysis study.</a> J Neurol. 253 (5), 594-600 (2006).</li><li>Grunt, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reproducibility+and+validity+of+video+screen+measurements+of+gait+in+children+with+spastic+cerebral+palsy.">Reproducibility and validity of video screen measurements of gait in children with spastic cerebral palsy.</a> Gait Posture. 31 (4), 489-494 (2010).</li><li>Womersley, L., May, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sitting+posture+of+subjects+with+postural+backache.">Sitting posture of subjects with postural backache.</a> J Manipulative Physiol Ther. 29 (3), 213-218 (2006).</li><li>DeForge, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+4-aminopyridine+on+gait+in+ambulatory+spinal+cord+injuries:+a+double-blind,+placebo-controlled,+crossover+trial.">Effect of 4-aminopyridine on gait in ambulatory spinal cord injuries: a double-blind, placebo-controlled, crossover trial.</a> Spinal Cord. 42 (12), 674-685 (2004).</li><li>Lucareli, P. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+analysis+following+treadmill+training+with+body+weight+support+versus+conventional+physical+therapy:+a+prospective+randomized+controlled+single+blind+study.">Gait analysis following treadmill training with body weight support versus conventional physical therapy: a prospective randomized controlled single blind study.</a> Spinal Cord. 49 (9), 1001-1007 (2011).</li><li>Lucareli, P. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=[Gait+analysis+and+quality+of+life+evaluation+after+gait+training+in+patients+with+spinal+cord+injury].">[Gait analysis and quality of life evaluation after gait training in patients with spinal cord injury].</a> Rev Neurol. 46 (7), 406-410 (2008).</li><li>McFadyen, B. J., Swaine, B., Dumas, D., Durand, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+effects+of+a+traumatic+brain+injury+on+locomotor+capacity:+a+first+study+of+spatiotemporal+patterns+during+unobstructed+and+obstructed+walking.">Residual effects of a traumatic brain injury on locomotor capacity: a first study of spatiotemporal patterns during unobstructed and obstructed walking.</a> J Head Trauma Rehabil. 18 (6), 512-525 (2003).</li><li>Shin, J. C., Yoo, J. H., Jung, T. H., Goo, H. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+lower+extremity+motor+score+parameters+for+patients+with+motor+incomplete+spinal+cord+injury+using+gait+parameters.">Comparison of lower extremity motor score parameters for patients with motor incomplete spinal cord injury using gait parameters.</a> Spinal Cord. 49 (4), 529-533 (2011).</li><li>Reid, S., Held, J. M., Lawrence, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+and+Validity+of+the+Shaw+Gait+Assessment+Tool+for+Temporospatial+Gait+Assessment+in+People+With+Hemiparesis.">Reliability and Validity of the Shaw Gait Assessment Tool for Temporospatial Gait Assessment in People With Hemiparesis.</a> Arch Phys Med Rehabil. 92 (7), 1060-1065 (2011).</li><li>Stokic, D. S., Horn, T. S., Ramshur, J. M., Chow, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Agreement+Between+Temporospatial+Gait+Parameters+of+an+Electronic+Walkway+and+a+Motion+Capture+System+in+Healthy+and+Chronic+Stroke+Populations.">Agreement Between Temporospatial Gait Parameters of an Electronic Walkway and a Motion Capture System in Healthy and Chronic Stroke Populations.</a> Am J Phys Med Rehabil. 88 (6), 437-444 (2009).</li><li>Arazpour, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+a+novel+powered+hip+orthosis+for+walking+by+a+spinal+cord+injury+patient:+a+single+case+study.">Evaluation of a novel powered hip orthosis for walking by a spinal cord injury patient: a single case study.</a> J. Prosthet. Orthot. Int. 36 (1), 105-112 (2012).</li><li>Prado-Medeiros, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+the+addition+of+functional+electrical+stimulation+to+ground+level+gait+training+with+body+weight+support+after+chronic+stroke.">Effects of the addition of functional electrical stimulation to ground level gait training with body weight support after chronic stroke.</a> Revista Brasileira De Fisioterapia. 15 (6), 436-444 (2011).</li><li>Sousa, C. O., Barela, J. A., Prado-Medeiros, C. L., Salvini, T. F., Barela, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+training+with+partial+body+weight+support+during+overground+walking+for+individuals+with+chronic+stroke:+a+pilot+study.">Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study.</a> J Neuroeng Rehabil. 8 (48), (2011).</li><li>Krebs, D. E., Edelstein, J. E., Fishman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+observational+kinamatic+gait+analysis.">Reliability of observational kinamatic gait analysis.</a> J Am Phys Ther Assoc. 65, 1027-1033 (1995).</li><li>Martin, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=More+than+half+of+MDs+under+age+35+now+using+PDAs.">More than half of MDs under age 35 now using PDAs.</a> Can. Med. Assoc. J. 169 (9), 952 (2003).</li><li>Mosa, A. M., Yoo, I., Sheets, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Systematic+Review+of+Healthcare+Applications+for+Smartphones.">A Systematic Review of Healthcare Applications for Smartphones.</a> BMC Med Inform Decis Mak. 12, (2012).</li><li>Ferriero, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+a+smartphone-based+goniometer+for+knee+joint+goniometry.">Reliability of a smartphone-based goniometer for knee joint goniometry.</a> Int J Rehabil Res. 36 (2), 146-151 (2013).</li><li>Vohralik, S. L., Bowen, A. R., Burns, J., Hiller, C. E., Nightingale, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+and+validity+of+a+smartphone+app+to+measure+joint+range.">Reliability and validity of a smartphone app to measure joint range.</a> Am J Phys Med Rehabil. 94 (4), 325-330 (2015).</li><li>Scholtes, S. S., Gretchen, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ability+to+detect+change+in+single+leg+squat+movement+patterns+following+instruction+in+females+with+patellofemoral+pain+using+2D+motion+analysis+methods.">Ability to detect change in single leg squat movement patterns following instruction in females with patellofemoral pain using 2D motion analysis methods.</a> Combined Sections Meeting. , (2014).</li><li>Eltoukhy, M. A., Asfour, S., Thompson, C., Latta, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+performance+of+digital+video+analysis+of+human+motion:+dartfish+tracking+system.">Evaluation of the performance of digital video analysis of human motion: dartfish tracking system.</a> IJSER. 3 (3), 1-6 (2012).</li><li>Boone, D. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+goniometric+measurements.">Reliability of goniometric measurements.</a> Phys Ther. 58 (11), 1355-1360 (1978).</li><li>Bovens, A. M., van Baak, M. A., Vrencken, J. G., Wijnen, J. A., Verstappen, F. 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The purpose of this validation study was to determine the validity of a freely available smartphone application in order to be clinically used as an objective and cost effective means of using smartphone technology for kinematic gait analysis in the clinical setting. Existing validation studies that examined kinematic measures with a smartphone application are limited and have not assessed dynamic kinematic measures recorded during gait in the sagittal plane. This validation study is the first to have examined kinematic ...

Assessment of human gait is a key component of the physical therapy evaluation and clinical decision-making process.1 Gait assessment is a frequently used clinical tool to assess gait deficits in patients with neurological and musculoskeletal deficits. Reassessment of gait can then provide the clinician with information about the efficacy of an intervention in achieving the goals they had set at their initial evaluation. There is a nationally recognized need in the United States for physical therapists to utilize standardized outcome measurements when evaluating patients.2 This need stems from the rapidly changing landscape of insurance reimbursement policies, as well as an emphasized shift for physical therapists to rely more heavily on evidence based practices.3 There are numerous outcome measures to assess different aspects of gait, which can be observed in a number of ways including: visual observation by a clinician, functional assessments, video recorded measures, electronic walkways, three-dimensional motion analysis software, etc. In clinical settings, observational (visual) gait analysis is commonly performed, as it requires minimal equipment and time.
While observational gait analysis is commonly used within the clinic, it still remains a subjective assessment.4 Therefore, factors such as therapist experience, visual acuity, distance from the subject (camera distance), measurement tools, and any other such factors can introduce variability and error in the assessment. The potential for such variability presents a critical need for a more reliable means of measurement, which can ultimately be overcome by the use of valid instrumentation.5
Since its inception, videography and related technology has been used to examine various functional limitations resulting from impaired movement capability as well as a form of visual feedback. This is acutely true in regards to gait assessment. Stuberg et al. found that &#34;videography equipment is commonly available in the clinic&#8230;and provides the clinician with additional objective information on posture and joint position during the gait cycle.&#34;4 As technology has continued to improve, so have the capabilities of video analysis. These capabilities provide the physical therapist with greater ability to clinically assess the various parameters of gait.
The two key parameters that physical therapists focus on include kinematic and spatiotemporal parameters. As the name implies, spatiotemporal measures involve elements of distance and time. Specific to a gait cycle, spatiotemporal measures would include, but not be limited to, stride length, step length, cadence, and velocity.6 Kinematic measures on the other hand focus on the joint movements/rotations of the lower extremities observed during each gait cycle.
A number of peer-reviewed articles have been published that have cited the use of video motion analysis as an outcome measure, specifically 2D camera systems, to assess kinematic, spatiotemporal, or a combination of both types of parameters. These articles have evaluated various clinical populations including individuals with a history of a stroke (CVA), traumatic brain injuries (TBI), spinal cord injuries (SCI), Parkinson&#39;s disease (PD), cerebral palsy (CP), and healthy individuals. The schematic presented below (Figure 1) provides the framework that was adopted to identify relevant peer-reviewed literature that has been published on this topic.
<img alt="Figure 1" src="/files/ftp_upload/54659/54659fig1.jpg" /> 
Figure 1. Schematic for Article Selection Criteria. The schematic outlines the steps used in choosing peer-reviewed articles to ascertain the type of variables that were reported in gait analysis. <a href="http://cloudflare.jove.com/files/ftp_upload/54659/54659fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
The majority of the research studies that have used video motion analysis for recording gait parameters were validation studies. Kinematic validation studies can be further broken down into one of three categories: assessing abnormal motion resulting from a specific diagnosis/pathology,7 examining joint angles during specific functional motions,8,9 and evaluating the effectiveness of treatment via comparison of pre-intervention motion and post-intervention motion.10,11 Similarly, research studies assessing spatiotemporal parameters can also be broken down into three categories: assessment of abnormal motion resulting from a specific pathology,12,13,14 examination of a platform during a specific functional activity,15,16 and determination of the effect of a specific intervention.17 The research studies that evaluated both kinematic and spatiotemporal parameters were primarily aimed at determining the effectiveness of specific treatment interventions such as orthoses 17 or body weight/partial body weight supported treadmill training.18,19 A preliminary descriptive analysis of these articles determined that 52.1% of the studies (the sum of those looking solely at kinematics (30.4%) and those that examined a combination of parameters (21.7%)) researched kinematic parameters with a 2D camera system. This is in comparison to the 69.5% of the articles (sum of articles that researched spatiotemporal parameters (47.8%) and a combination of parameters (21.7%)) that assessed spatiotemporal parameters.
The methodological differences in recording and assessing kinematic and spatiotemporal gait parameters are also seen in clinical practice in terms of the type of observational gait analysis being used. Spatiotemporal parameters are assessed with much greater frequency as indicated by the research. There are three generally agreed upon reasons for this trend: low cost, ease of use, and the existence of a standard protocol to measure such parameters. Observational kinematic measurements have been shown to have very low intra-rater (60%) and inter-rater reliability (40% - 94%) in clinical settings.4 This wide range is understood to be due to the variation in the placement of markers on bony landmarks and the specific tools used to assess joint angles. Minute differences in location placement of the markers can significantly alter the resultant angles. Spatiotemporal measurements have much higher reliability (ranging 69% - 97%), especially when using the paper, pencil and stop clock method to assess gait.20
The technological advances in the last few decades have significantly changed the way healthcare is practiced. With the recent emergence of smartphones, access to the Internet, online research articles, and other electronic resources are now more readily available to clinicians at any time. Martin et al. reported that &#34;general use of smartphones is increasing in clinical practice, medical education and research.&#34;21 In this study, more than 50% of medical doctors under the age of 35 responded that they have implemented using a smartphone in clinical practice. This trend increased in 2009 when 64% of physicians in the United States were found to be using smartphones in their clinical practice. The Manhattan Review study further predicted that this growth would continue to climb to 81% of physicians and healthcare clinicians implementing smartphone usage in clinical practice by 2012.22 While further research has not been conducted to determine if this upward trend has indeed continued to climb, it is reasonable to assume, with the known implementation of technology in healthcare, that the use of smartphone platforms in clinical practice will become more commonplace.
The current use of smartphone applications in physical therapy practice has not been established. There have been no studies evaluating the use of smartphone video analysis applications by a physical therapist to date. However, various smartphone applications have been used by individual physical therapists as a breakthrough assistive tool in outpatient orthopedic settings for use in both rehabilitating and training athletes of various disciplines. Smartphone apps are also available that can measure joint angles, some of which have been validated.23,24 Individual therapists have begun using various analysis applications on smartphones for visual feedback for the patient and for easier breakdown of various components that may be lacking in a patient&#39;s gait cycle, based on anecdotal evidence. However, the validity of these measures remains unknown. The limited research that does exist regarding these smartphone video analysis applications has focused on the validation of kinematic gait parameters, specifically ankle, knee and hip angles, in the frontal plane,25 and inter-rater reliability of the device.26 There are no studies to date that have validated the use of smartphone video analysis applications to record kinematics of gait in the sagittal plane, which is most commonly performed in clinical gait analysis.
The purpose of this study was to test the concurrent validity of kinematic measures recorded by the smartphone application and compare them to measures recorded by a 3D motion capture system in the sagittal plane. We predict that there will be no significant differences between the measures recorded by the smartphone application when compared to the measures recorded by the 3D motion capture system. The secondary purpose is to test if two distinct placements of the smartphone camera from the subject (near distance of 2-m; far distance of 4 -nt difference in measures between the two distinct placements of the smartphone camera. The final purpose of the study is to draft a protocol for clinical video gait analysis using a smartphone application.

<table border="0" cellpadding="0" cellspacing="0" width="655">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:247px;">Hudl Technique App</td>
			<td style="width:81px;">Hudl&#160;</td>
			<td style="width:136px;">Online app</td>
			<td style="width:191px;">Freely downladable app from adroid /apple store</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:247px;">Optotrak Certus 3D motion capture system</td>
			<td style="width:81px;">Northern Digital inc</td>
			<td style="width:136px;">Optotrak certus System</td>
			<td>http://www.ndigital.com/msci/products/optotrak-certus/</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:247px;">Smartphone</td>
			<td style="width:81px;">Apple</td>
			<td style="width:136px;">Iphone 5</td>
			<td>www.apple.com</td>
		</tr>
	</tbody>
</table>

video movement analysis using smartphones (vimas): a pilot study

The use of smartphones in clinical practice is steadily increasing with the availability of low cost/freely available &#34;apps&#34; that could be used to assess human gait. The primary aim of this manuscript is to test the concurrent validity of kinematic measures recorded by a smartphone application in comparison to a 3D motion capture system in the sagittal plane. The secondary aim was to develop a protocol for clinicians on the set up of the smartphone camera for video movement analysis.
The sagittal plane knee angle was measured during heel strike and toe off events using the smart phone app and a 3D motion-capture system in 32 healthy subjects. Three trials were performed at near (2-m) and far (4-m) smartphone camera distances. The order of the distances was randomized. Regression analysis was performed to estimate the height of the camera based on either the subject&#39;s height or leg length.
Absolute measurement errors were least during toe off (3.12 &#177; 5.44 degrees) compared to heel strike (5.81 &#177; 5.26 degrees). There were significant (p &#60; 0.05) but moderate agreements between the application and 3D motion capture measures of knee angles. There were also no significant (p &#62; 0.05) differences between the absolute measurement errors between the two camera positions. The measurement errors averaged between 3 - 5 degrees during toe off and heel strike events of the gait cycle.
The use of smartphone apps can be a useful tool in the clinic for performing gait or human movement analysis. Further studies are needed to establish the accuracy in measuring movements of the upper extremity and trunk.

All 32 subjects completed the 6 walking trials; however, data from 6 of the participants were not included in the data analysis due to technical problems resulting in poor marker visibility. The absolute measurement errors of knee angles were least during toe off events (3.12 &#177; 5.44 degrees) compared to heel strike (5.81 &#177; 5.26 degrees) (Table 1b). There were no statistically significant agreements (P &#62; 0.05) between the smartphone application and 3D motion ...

Watch this Scientific Journal Video about Video Movement Analysis Using Smartphones ViMAS: A Pilot Study at JoVE.com

Video Movement Analysis Using Smartphones ViMAS: A Pilot Study

This manuscript describes the method to test the concurrent validity of kinematic measures recorded by the smartphone application in comparison to a 3D motion capture system in the sagittal plane. This protocol will enable clinicians to set up smartphones for video capture of human movement.

Video Movement Analysis Using Smartphones (ViMAS): A Pilot Study

The use of smartphones in clinical practice is steadily increasing with the availability of low cost/freely available &#34;apps&#34; that could be used to ...

The overall goal of this study is to test the concurrent validity of kinematic measures recorded by the smart phone application, and compare them to measures recorded by a 3D motion capture system, in order to develop a valid clinical protocol. This clinical protocol has been developed, so that the smartphone can be used to capture human movement, and provide valid kinematic measurements, using a simple and user-friendly set-up. The main advantage of this technique is that the smartphone can be set up in a clinic or a patient's home, for video analysis of human movement.Visual demonstration of this method is critical, because clinicians can follow the step-by-step clinical protocol, in order to obtain valid measures of lower extremity kinematics. Demonstrating the procedure will be graduate students, who are coauthors in the study. Begin by measuring and marking off a six-meter walkway, using measuring tape and sticky tape.Then place four 3D motion capture cameras at the four corners of the six-meter walkway, to record walking in this area. Orient each of the cameras at the diagonal ends of the walkway to face each other. Next, escort the participant into the testing area, and collect weight and leg length, from the greater trochanter to the medial malleoli of both legs with a measuring tape.Then measure the height by having the participant stand barefoot next to a measuring tape, attached to the wall. Place a ruler on top of the participant's head to read the measurement from the measuring tape adhered to the wall. Mount the smart phone on a tripod, using an adapter clip to hold the smart phone.Place the tripod perpendicular to the center of the walkway, at 2.0 meters away from the first setted trial. Note the tripod should be placed at 4.0 meters away for the second set of trials. Then calculate the height from the floor to the camera lens in meters for each configuration, using the patient's leg length.The near camera position, two meters, is for recording and analyzing only the lower extremity movement whereas the far distance covers both lower extremity and trunk. Next, place clusters of three smart markers with velcro straps on the bilateral anterior superior iliac crest or ASIS, upper one-third of the lateral aspect of the thighs, upper one-third of the lateral aspect of the calves, and the dorsum of both feet. Place a single smart marker on the midline between the right and left posterior superior iliac spines.Place stickers indicating bony landmarks of the bilateral medial and lateral femoral condyles, medial and lateral malleoli, and the webbed space between first and second toes for calibration of the 3D motion capture system. Finally, calibrate the equipment using an instrumented wand with smart markers on it, to register the 3D location of the stickers. To begin, have one investigator operate the smartphone, and the other operating the computer that controls the 3D motion capture system.Ask the participant to complete a practice trial. Then, open the smartphone application and press the red record button on the bottom center of the screen to begin recording. Use numbered paper to indicate trial number on the smartphone recording.Then, instruct the participant to walk at their normal pace, and to focus on a marker placed on the opposite wall to assist in walking in a straight line. Give the participant a countdown to start by saying three, two, one, go. Then, have the participant cross the first two 3D motion capture cameras placed at the beginning of the walkway on either side, and walk towards another two cameras placed at the other end of the walkway on either side.After the subject finishes walking the six meter distance, countdown to the end of the trial by saying three, two, one, stop. Then press the red record button once more to stop recording the walking trial. Check all markers for position after each trial.Next, move the tripod with the smartphone to the second distance four meters away to capture the upper and lower body. Ask the participant to stand on the midpoint of the walkway, then start walking in the same manner as before. Finally, save and verify the 3D motion capture recordings and smartphone recordings.Then remove the smart markers. Begin by manually recording the knee angle that is displayed on the screen at the heel strike and toe off phases of the gait cycle. Then, complete the analysis of smart phone recordings for heel strike and toe off events.Use the stylus for increased accuracy of landmark placement for knee angle measurements. Next, view that was just recorded by selecting the video square in the bottom left corner of the screen. Use the scrollbar at the base of the screen to select the frame in which the subject is closest to heel strike or toe off in the center of the screen.Then, to drop in the angle, tap on the white outline pencil icon on the upper right side of the screen. Select the angle option in the drop down menu. Choose a preferred color and the angle marker.Slide or tap the stylus anywhere on the screen to drop in the angle. Finally, place the center of the angle on the knee joint, with the vectors reaching upwards along the femur and downwards towards the lateral malleoli. If needed, zoom in by placing two fingers close together in the center of the screen and slowly drawing them apart from one another.Based on the results, there was a significant difference between the angle measurements by the 3D motion capture system and smartphone application. The plots for the 4.0 meter and the 2.0 meter distances displayed data that are more scattered around the mean difference line in the center. This indicates that the camera position did not contribute to the errors in measurements.While attempting the clinical protocol for smartphone video movement analysis, it's important to remember that the camera must be placed at the set distance and the height of the camera is determined by the individual's leg length.

video-movement-analysis-using-smartphones-vimas-a-pilot-study

Research

JoVE Journal

Medicine

Human Neuroendocrine Tumor Cell Lines as a Three-Dimensional Model for the Study of Human Neuroendocrine Tumor Therapy

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human malignancies.1 Other than surgery for the minority of patients who present with localized disease, there is little or no survival benefit of systemic therapy. Therefore, there is a great need to better understand the biology of NETs, and in particular define new therapeutic targets for patients with nonresectable or metastatic neuroendocrine tumors. 3D cell culture is becoming a popular method for drug screening due to its relevance in modeling the in vivo tumor tissue organization and microenvironment.2,3 The 3D multicellular spheroids could provide valuable information in a more timely and less expensive manner than directly proceeding from 2D cell culture experiments to animal (murine) models.
To facilitate the discovery of new therapeutics for NET patients, we have developed an in vitro 3D multicellular spheroids model using the human NET cell lines. The NET cells are plated in a non-adhesive agarose-coated 24-well plate and incubated under physiological conditions (5% CO2, 37 &deg;C) with a very slow agitation for 16-24 hr after plating. The cells form multicellular spheroids starting on the 3rd or 4th day. The spheroids become more spherical by the 6th day, at which point the drug treatments are initiated. The efficacy of the drug treatments on the NET spheroids is monitored based on the morphology, shape and size of the spheroids with a phase-contrast light microscope. The size of the spheroids is estimated automatically using a custom-developed MATLAB program based on an active contour algorithm. Further, we demonstrate a simple method to process the HistoGel embedding on these 3D spheroids, allowing the use of standard histological and immunohistochemical techniques. 
This is the first report on generating 3D spheroids using NET cell lines to examine the effect of therapeutic drugs. We have also performed histology on these 3D spheroids, and displayed an example of a single drug's effect on growth and proliferation of the NET spheroids. Our results support that the NET spheroids are valuable for further studies of NET biology and drug development.

We present a simple agarose overlay platform to grow 3D multicellular spheroids using neuroendocrine cancer cell lines. This method provides a very convenient way to examine the effect of therapeutic drugs on the neuroendocrine tumor cells. It could also help us establish human neuroendocrine tumor spheroids for cancer therapy.

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human ...

Movement Retraining using Real-time Feedback of Performance

Any modification of movement - especially movement patterns that have been honed over a number of years - requires re-organization of the neuromuscular patterns responsible for governing the movement performance. This motor learning can be enhanced through a number of methods that are utilized in research and clinical settings alike. In general, verbal feedback of performance in real-time or knowledge of results following movement is commonly used clinically as a preliminary means of instilling motor learning. Depending on patient preference and learning style, visual feedback (e.g. through use of a mirror or different types of video) or proprioceptive guidance utilizing therapist touch, are used to supplement verbal instructions from the therapist. Indeed, a combination of these forms of feedback is commonplace in the clinical setting to facilitate motor learning and optimize outcomes.
Laboratory-based, quantitative motion analysis has been a mainstay in research settings to provide accurate and objective analysis of a variety of movements in healthy and injured populations. While the actual mechanisms of capturing the movements may differ, all current motion analysis systems rely on the ability to track the movement of body segments and joints and to use established equations of motion to quantify key movement patterns. Due to limitations in acquisition and processing speed, analysis and description of the movements has traditionally occurred offline after completion of a given testing session.
This paper will highlight a new supplement to standard motion analysis techniques that relies on the near instantaneous assessment and quantification of movement patterns and the display of specific movement characteristics to the patient during a movement analysis session. As a result, this novel technique can provide a new method of feedback delivery that has advantages over currently used feedback methods.

Retraining abnormal movement patterns following injury or disease is a key component of physical rehabilitation. Recent advances in technology have permitted accurate assessment of movement during a variety of tasks, with near instantaneous quantification of results. This provides new opportunities for modification of faulty movement patterns in real time.

Any modification of movement - especially movement patterns that have been honed over a number of years - requires re-organization of the neuromuscular ...

Measurement of Dynamic Scapular Kinematics Using an Acromion Marker Cluster to Minimize Skin Movement Artifact

The measurement of dynamic scapular kinematics is complex due to the sliding nature of the scapula beneath the skin surface. The aim of the study was to clearly describe the acromion marker cluster (AMC) method of determining scapular kinematics when using a passive marker motion capture system, with consideration for the sources of error which could affect the validity and reliability of measurements. The AMC method involves placing a cluster of markers over the posterior acromion, and through calibration of anatomical landmarks with respect to the marker cluster it is possible to obtain valid measurements of scapular kinematics. The reliability of the method was examined between two days in a group of 15 healthy individuals (aged 19-38 years, eight males) as they performed arm elevation, to 120&#176;, and lowering in the frontal, scapular and sagittal planes. Results showed that between-day reliability was good for upward scapular rotation (Coefficient of Multiple Correlation; CMC = 0.92) and posterior tilt (CMC = 0.70) but fair for internal rotation (CMC = 0.53) during the arm elevation phase. The waveform error was lower for upward rotation (2.7&#176; to 4.4&#176;) and posterior tilt (1.3&#176; to 2.8&#176;), compared to internal rotation (5.4&#176; to 7.3&#176;). The reliability during the lowering phase was comparable to results observed during the elevation phase. If the protocol outlined in this study is adhered to, the AMC provides a reliable measurement of upward rotation and posterior tilt during the elevation and lowering phases of arm movement.

This report presents details of how to adopt the acromion marker cluster method of obtaining scapular kinematics when using a passive marker motion capture device. As has been described in the literature, this method provides a robust, non-invasive, three-dimensional, dynamic and valid measurement of scapular kinematics, minimizing skin movement artifact.

The measurement of dynamic scapular kinematics is complex due to the sliding nature of the scapula beneath the skin surface. The aim of the study was to ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Using the Sleeve Technique in a Mouse Model of Aortic Transplantation - An Instructional Video

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the aorta in mice using the sleeve method was short and easy averaging 20 min, permitting studies of iso/allo grafts. The following article describes the aortic transplantation procedure used in our laboratory. The mice were anesthetized with a mixture of 1.5% volume isoflurane and 100% oxygen through a face mask. At this point, the segment of the aorta between the renal arteries and its bifurcation was separated from the vena cava, freely prepared and clampedat the proximal and distal segments with a single silk suture. Prior to the removal of the aorta, a saline solution containing heparin was injected into the inferior vena cava. Then the aorta was cut between the clamps and a saline heparin solution was used to flush the lumen. The sleeve technique with monofilament sutures was used in order to transplant the abdominal aorta in the orthotopic position.

We present an orthotopic aortic transplantation model using the sleeve technique in mice. It is a very rapid anastomosis method, which can be employed in studies of vascular disease.

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the ...

3D Ultrasound Imaging: Fast and Cost-effective Morphometry of Musculoskeletal Tissue

The developmental goal of 3D ultrasound imaging (3DUS) is to engineer a modality to perform 3D morphological ultrasound analysis of human muscles. 3DUS images are constructed from calibrated freehand 2D B-mode ultrasound images, which are positioned into a voxel array. Ultrasound (US) imaging allows quantification of muscle size, fascicle length, and angle of pennation. These morphological variables are important determinants of muscle force and length range of force exertion. The presented protocol describes an approach to determine volume and fascicle length of m.&#160;vastus lateralis and m.&#160;gastrocnemius medialis. 3DUS facilitates standardization using 3D anatomical references. This approach provides a fast and cost-effective approach for quantifying 3D morphology in skeletal muscles. In healthcare and sports, information on the morphometry of muscles is very valuable in diagnostics and/or follow-up evaluations after treatment or training.

3D ultrasound imaging (3DUS) allows fast and cost-effective morphometry of musculoskeletal tissues. We present a protocol to measure muscle volume and fascicle length using 3DUS.

The developmental goal of 3D ultrasound imaging (3DUS) is to engineer a modality to perform 3D morphological ultrasound analysis of human muscles. 3DUS ...

Using Retinal Imaging to Study Dementia

The retina offers a unique &#8220;window&#8221; to study pathophysiological processes of dementia in the brain, as it is an extension of the central nervous system (CNS) and shares prominent similarities with the brain in terms of embryological origin, anatomical features and physiological properties.&#160; The vascular and neuronal structure in the retina can now be visualized easily and non-invasively using retinal imaging techniques, including fundus photography and optical coherence tomography (OCT), and quantified semi-automatically using computer-assisted analysis programs. Studying the associations between vascular and neuronal changes in the retina and dementia could improve our understanding of dementia and, potentially, aid in diagnosis and risk assessment.&#160; This protocol aims to describe a method of quantifying and analyzing retinal vasculature and neuronal structure, which are potentially associated with dementia. This protocol also provides examples of retinal changes in subjects with dementia, and discusses technical issues and current limitations of retinal imaging.

The retina shares prominent similarities with the brain and thus represents a unique window to study vasculature and neuronal structure in the brain non-invasively. This protocol describes a method to study dementia using retinal imaging techniques. This method can potentially aid in diagnosis and risk assessment of dementia.

The retina offers a unique &#8220;window&#8221; to study pathophysiological processes of dementia in the brain, as it is an extension of the central ...

A Novel Approach to Overcome Movement Artifact When Using a Laser Speckle Contrast Imaging System for Alternating Speeds of Blood Microcirculation

The laser speckle contrast imager (LSCI) provides a powerful yet simple technique for measuring microcirculatory blood flow. Ideal for blood dynamic responses, the LSCI is used in the same way as a conventional Laser Doppler Imager (LDI). However, with a maximum skin depth of approximately 1 mm, the LSCI is designed to focus on mainly superficial blood flow. It is used to measure skin surface areas of up to 15 cm x 20 cm. The new technique introduced in this paper accounts for alternating speeds of microcirculations; i.e. both slow and fast flow flux measurement using the LSCI. The novel technique also overcomes LSCI&#39;s biggest shortcoming, which is high sensitivity to artifact movement. An adhesive opaque patch (AOP) is introduced for satisfactory recording of microcirculatory blood flow, by subtracting the LSCI signal from the AOP from the laser speckle skin signal. The optimal setting is also defined because the LSCI is most powerful when flux changes are measured relative to a reference baseline, with blood microcirculatory flux expressed as a percentage change from the baseline. These changes may be used for analyzing the status of the blood flow system.

This study introduces a novel technique for the measurement and analysis of alternating speeds of blood microcirculation in a single experiment using a laser speckle contrast imager.

The laser speckle contrast imager (LSCI) provides a powerful yet simple technique for measuring microcirculatory blood flow. Ideal for blood dynamic ...

Isometric Contractility Measurement of the Mouse Mesenteric Artery Using Wire Myography

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and drugs. It is widely used in many studies on the physiological functions of vascular smooth muscle, the pathogenesis of vascular diseases such as hypertension, and the development of smooth muscle relaxant drugs. The mouse is a widely used model animal with a large pool of disease models and genetically modified strains. We introduced this method to measure the isometric contraction of mouse mesenteric artery in detail. A 1.4-mm segment of mouse mesenteric resistance artery was isolated and mounted on a myograph chamber by passing two steel wires through its lumen. After equilibration and normalization steps, the vessel segment was potentiated by a high-K+ solution twice prior to the contraction assay. As an example of the application of this method in drug development, we measured the relaxant effect of a novel natural substance, neoliensinine, isolated from a Chinese herb, embryos of the lotus seed (Nelumbo nucifera Gaertn.) on mouse mesenteric arteries. The vessel segments mounted on the myograph chamber were stimulated with a high-K+ solution. When the force tension reached a stable sustained phase, cumulative doses of neoliensinine were added to the chamber. We found that neoliensinine had a dose-dependent relaxant effect on smooth muscle contraction, thus suggesting that it bears potential activity against hypertension. In addition, as the vessel segment can survive at least 4 hours after mounting and maintain contractility induced by the high-K+ solution for many times, we suggest that the wire myograph system may be used for the time-consuming process of drug screening.

The wire myograph technique is used to investigate vascular smooth muscle functions and screen new drugs. We report a detailed protocol for measuring the isometric contractility of the mouse mesenteric artery and for screening new relaxants of vascular smooth muscle.

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and ...

Comparing Bibliometric Analysis Using PubMed, Scopus, and Web of Science Databases

Literature databases (i.e., PubMed, Scopus, and Web of Science) differ in terms of their coverage, focus, and the tool they provide. PubMed focuses mainly on life sciences and biomedical disciplines, whereas Scopus and Web of Science are multidisciplinary. The protocol described in the current study was used to search for publications from Jordanian authors in the years 2013-2017. In this protocol, how to use each database to conduct this type of search is explained in detail. A Scopus search resulted in the highest number of documents (11,444 documents), followed by a Web of Science search (10,943 documents). PubMed resulted in a smaller number of documents due to its narrower scope and coverage (4,363 documents). The results also show a yearly trend in: (1) the number of publications, (2) the disciplines that have the most publications, (3) the countries of collaboration, and (4) the number of open access publications. In contrast, PubMed has a sophisticated keyword optimization service (i.e., Medical Subject Heading, or MeSH), while both Scopus and Web of Science provide search analysis tools that can produce representative figures. Finally, the features of each database are explained in detail and several indices that can be extracted using the search results are provided. This study provides a base for using literature databases for bibliometric analysis.

Literature databases are commonly used to assess publications in a certain subject, discipline, country, or region of the world, a practice known as bibliometric analysis. The current protocol details how to use PubMed, Scopus, and Web of Science databases to do bibliometric analysis.

Literature databases (i.e., PubMed, Scopus, and Web of Science) differ in terms of their coverage, focus, and the tool they provide. PubMed focuses mainly ...