3D Digital Twin Visualization of Multiclass GRF-Based Gait Disorder Classification

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 $\pm$ 4.0 years; 60 distinct primary diagnoses, cerebral palsy the most common at $n=54$), the sagittal-view model achieved $R^2 = 0.80 \pm 0.02$ and CCC $= 0.89 \pm 0.02$ for knee z-scores and $R^2 = 0.57 \pm 0.02$ and CCC $= 0.72 \pm 0.02$ 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 $43 \pm 1$% 7-class accuracy with macro-AUROC $= 0.78 \pm 0.01$, 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.

Pathological gait datasets remain scarce due to privacy, recruitment, cost, and movement variability. Our work presents a multimodal LLM-guided framework for pathology-aware 3D gait data synthesis from structured textual descriptions. The proposed method generates fixed-length synthetic skeleton-based gait sequences for pathological gait classification tasks. The framework combines motion tokenisation, pathology-aware language conditioning, LLM-based semantic augmentation, and language-to-gait generation. A key contribution is the proposed pathological tokeniser, which is designed to preserve pathology-specific motion characteristics during discrete representation learning. Experiments suggest that the proposed synthetic sequences improve downstream classification for recurrent classifiers when combined with real data. The best result is obtained using a GRU classifier trained with real and synthetic samples, achieving 92.77% accuracy under a leave-one-subject-out protocol.

Gait recognition is shaped by its input representation. Silhouettes encode projected body shape, skeletons encode sparse joint coordinates, and 3D meshes encode dense surface geometry. In each case, identity-bearing articulation is observed through geometric carriers that also vary with clothing, skeletal scale, or body shape. We investigate whether gait can instead be recognized from compact articulated controls. We introduce Momentum Human Rig (MHR) pose as a gait representation, describing each frame using 184 semantically organized body and hand parameters estimated from monocular video. MHRGait groups these heterogeneous controls by anatomy, models their intra-frame coordination and temporal evolution, and produces compact body and hand descriptors. We further introduce MHRGait++, which combines MHR pose with silhouettes through modality-balanced distance fusion, preventing descriptor count from determining modality importance. Experiments on four benchmarks show that MHRGait attains the best overall performance among compared model-based methods on CCPG and SUSTech1K and transfers effectively across datasets, while its recognition network requires only 2.76M parameters and 0.69 GFLOPs for a 30-frame input. MHRGait++ consistently improves silhouette recognizers with a favorable accuracy-efficiency trade-off. These results establish rig-space articulation as an effective standalone gait representation and a complementary cue to projected body shape. Our code is available at https://github.com/duanhuiran/MHRGait.