Quantifying Rodda and Graham Gait Classification from 3D Markerless Kinematics derived from a Single-view Video in a Heterogeneous Pediatric Clinical Cohort
Authors: Lauhitya Reddy, Seth Donahue, Jeremy Bauer, Susan Sienko, Anita Bagley, Joseph Krzak, Maura Eveld, Karen Kruger, +3 more
Organizations: Department of Biomedical Informatics, Emory University, Atlanta, GA, USA · Shriners Children’s, USA · The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
Cerebral Palsy (CP) is a neurological disorder of movement and the most common cause of lifelong physical disability in childhood. Approximately 75% of children with CP are ambulatory, and accurate gait assessment is central to preserving walking function, which deteriorates by mid-adulthood in a quarter to half of adults with CP. The Rodda and Graham classification system quantifies sagittal-plane gait deviations using ankle and knee z-scores derived from 3D Instrumented Gait Analysis (3D-IGA), but 3D-IGA is expensive and limited to specialized centers, while observational assessment shows only moderate inter-rater agreement. We developed a markerless gait analysis pipeline that quantifies Rodda and Graham knee and ankle z-scores directly from single-view clinical gait videos. Across 1,058 bilateral limb samples from 529 trials of 152 children (88 male, 63 female; age 12.1 ± 4.0 years; 60 distinct primary diagnoses, cerebral palsy the most common at n=54), the sagittal-view model achieved R2=0.80±0.02 and CCC =0.89±0.02 for knee z-scores and R2=0.57±0.02 and CCC =0.72±0.02 for ankle z-scores against 3D-IGA. Binary screening for excess knee flexion achieves AUROC =0.88, correctly identifying 83% of affected children, and applying Rodda and Graham rules yields 43±1% 7-class accuracy with macro-AUROC =0.78±0.01, ankle prediction error remaining the primary bottleneck. Beyond cross-sectional screening, continuous z-scores support longitudinal trajectory tracking across visits, providing a quantitative substrate for monitoring disease progression and treatment response unavailable from observational scales. These results demonstrate the feasibility of video-based z-score estimation, excess-flexion screening, and longitudinal trajectory tracking as a path toward scalable, objective gait assessment in low-resource clinical settings.
We introduce a new problem domain for human action recognition: the fine-grained analysis of children's gait behaviors from standard RGB video. We specifically target the ambulatory patterns of children aged 3-17 years. Such behaviors arise naturally in the diagnosis and treatment of several critical developmental and neuromuscular disorders, such as cerebral palsy and hemiplegia. Despite their clinical value, current 3D sensor-based gait analysis systems are expensive, intrusive, and often impractical for young subjects. To address this, we introduce a new dataset comprising over 1,100 high-frame-rate (60 FPS) video sequences from 110 subjects, accompanied by synchronized, anonymized pose sequences. In each session, the child performs a 5-second "walk-around" task, capturing the gait cycle from multiple viewpoints. Crucially, we demonstrate that current state-of-the-art approaches, including gait foundation models and Multimodal Large Language Models (MLLMs), fail to effectively resolve these clinical nuances. We identify the key technical challenges in analyzing these erratic and subtle motor patterns and describe a unified end-to-end framework for decoding fundamental components of pediatric gait. Through comprehensive experimental results, we demonstrate the potential of this dataset to drive novel research questions and establish a rigorous baseline for automated child gait assessment.
Automated gait analysis requires accurate classification and interpretable outputs. We propose an integrated framework for classifying healthy gait and multiple musculoskeletal impairment groups using bilateral ground reaction force (GRF) and center-of-pressure (COP) signals. The signals were normalized over the stance phase and standardized using training-set statistics. The model achieved a validation accuracy of 99.00% and a test accuracy of 90.07% under a session-level split. Class-specific ϵ-LRP identified positive and negative contributions across both sides, multiple signal components, and different stance phases. Separately, the processed GRF signals and model predictions were synchronized within a Blender-based 3D visualization, enabling sample-level inspection of gait trials and classification results. The proposed framework integrates classification, explainability, and 3D visualization to improve model transparency. The source code is available in the following repository: https://github.com/nyoico/grf-gait-3d-visualization.git
arly identification of motor impairment in infancy relies on expert visual assessment of spontaneous movement, motivating the development of automated, objective alternatives. One promising approach is using computer vision, which benefits from high quality pose estimation from video. In this study, we systematically evaluated three state-of-the-art pose estimation frameworks (MeTRAbs-ACAE, SAM 3D Body, and Sapiens) on 100 videos over 13 sessions of 8 infants recorded with a multi-view markerless motion capture system. We quantified keypoint detection accuracy using reprojection error, geometric consistency, and Procrustes-aligned 3D position error, and demonstrated proof-of-concept for fitting an inverse kinematic framework to infant data. While Sapiens achieved the lowest reprojection error and highest geometric consistency of the methods evaluated (22.8 pixels and 0.82, respectively), SAM 3D Body provided the most comprehensive 3D information for kinematic reconstruction with Procrustes-aligned position errors of 19 to 28 mm. We demonstrate in a case comparison example that biomechanical models fit to SAM 3D estimates distinguish representative movement patterns in infants related to motor development, as identified by a clinical expert. Together, these findings highlight both the promise and current limitations of 3D pose estimation for infant biomechanics and establish preliminary groundwork for scalable, video-based assessment of early motor development.