BioGait-VLM: A Tri-Modal Vision-Language-Biomechanics Framework for Interpretable Clinical Gait Assessment

Current automated gait analysis for clinical applications relies on uninterpretable black-box classifiers. Although Vision-Language Models (VLMs) offer strong reasoning capabilities, applying them directly to gait videos often leads to hallucinations, because they struggle to measure subtle geometric deviations from raw visual contexts. To address this, we introduce DrGait, a training-free agentic framework that shifts the VLM's role from a direct visual reasoner to a clinical planner. DrGait decouples semantic reasoning from geometric perception through a structured Triage-Verification-Synthesis (TVS) workflow. Given an input video and a set of basic spatiotemporal metrics, the DrGait agent first performs a heuristic triage to propose diagnostic hypotheses, which are then verified by autonomously calling deterministic biomechanical tools that operate on reconstructed 3D mesh trajectories, segmented 2D pose tracks, and event-centered video evidence. Finally, a closed-loop mechanism recursively updates the agent's reasoning context based on the feedback. By anchoring VLM's reasoning in verifiable geometric and temporal measurements, DrGait reduces hallucinations, achieving competitive diagnostic accuracy while generating transparent and audit-ready clinical reports.

What is a gait? Appearance-based gait networks consider a gait as the human shape and motion information from images. Model-based gait networks treat a gait as the human inherent structure from points. However, the considerations remain vague for humans to comprehend truly. In this work, we introduce a novel paradigm Vocabulary-Guided Gait Recognition, dubbed Gait-World, which attempts to explore gait concepts through human vocabularies with Vision-Language Models (VLMs). Although VLMs have achieved the remarkable progress in various vision tasks, the cognitive capability regarding gait modalities remains limited. The success element in Gait-World is the proper vocabulary prompt where this paradigm carefully selects gait cycle actions as Vocabulary Base, bridging the gait and vocabulary feature spaces and further promoting human understanding for the gait. How to extract gait features? Although previous gait networks have made significant progress, learning solely from gait modalities on limited gait databases makes it difficult to learn universal gait features for practicality. Therefore, we propose the first Gait-World model, dubbed α-Gait, which guides the gait network learning with vocabulary knowledge from VLMs. However, due to the heterogeneity of the modalities, directly integrating vocabulary and gait features is highly challenging as they reside in different embedding spaces. To address the issues, α-Gait designs Vocabulary Relation Mapper and Gait Fine grained Detector to map and establish vocabulary relations in the gait space for detecting corresponding gait features. Extensive experiments on CASIA-B, CCPG, SUSTech1K, Gait3D and GREW reveal the potential value and research directions of vocabulary information from VLMs in the gait field.

Gait silhouettes, which can be encoded into binary gait codes, are widely adopted to representing motion patterns of pedestrian. Recent approaches commonly leverage visual backbones to encode gait silhouettes, achieving successful performance. However, they primarily focus on continuous visual features, overlooking the discrete nature of binary silhouettes that inherently share a discrete encoding space with natural language. Large Language Models (LLMs) have demonstrated exceptional capability in extracting discriminative features from discrete sequences and modeling long-range dependencies, highlighting their potential to capture temporal motion patterns by identifying subtle variations. Motivated by these observations, we explore bridging binary gait silhouettes and natural language within a binary encoding space. However, the encoding spaces of text tokens and binary gait silhouettes remain misaligned, primarily due to differences in token frequency and density. To address this issue, we propose the Contour-Velocity Tokenizer, which encodes binary gait silhouettes while reshaping their distribution to better align with the text token space. We then establish a dual-branch framework termed Silhouette Language Model, which enhances visual silhouettes by integrating discrete linguistic embeddings derived from LLMs. Implemented on mainstream gait backbones, SilLang consistently improves state-of-the-art methods across SUSTech1K, GREW, and Gait3D.