Video-Based Markerless Motion Capture for Clinical and Rehabilitation Biomechanics: A PRISMA-ScR Scoping Review of Validated Architectures, Clinical Readiness, and Emerging Methods
Organizations: LAMHESS, CHU · LAMHESS, Université Côte d'Azur, Nice, France · LAMHESS · Plateforme Fragilité, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique de Soins Ambulatoires, Nice, France · IUF, LAMHESS · Institut Universitaire de France (IUF), France
Background.. Video-based markerless motion capture promises movement analysis without the cost, space and skin-marker constraints of optoelectronic systems, with particular potential for clinical and rehabilitation settings. Whether validated pipelines yet deliver clinically acceptable biomechanics, and how they relate to the underlying computer-vision research, remains unclear. Methods. We conducted a scoping review following the PRISMA extension for Scoping Reviews, with a registered protocol and searches of PubMed, Scopus and IEEE Xplore (January 2015 to February 2026; the computer-vision scan was updated to July 2026). A dual-tier design paired a primary corpus of validated biomechanical studies with a complementary, curated and deliberately non-exhaustive corpus of emerging computer-vision work, used qualitatively. We charted study characteristics, pipeline architecture, validation methods and joint-angle accuracy. Results. We included 117 studies, most published from 2024 onward and conducted on healthy adults walking in a laboratory. Pipelines formed five architectural families across monocular and multi-camera modalities; most reported raw joint angles without biomechanical refinement. Sagittal lower-limb agreement clustered around 5 to 6{\textdegree}, generally short of clinical acceptability, while out-of-plane kinematics, kinetics, and pathological or older populations were rarely validated. Emerging computer-vision building blocks (foundation-model mesh recovery, differentiable inverse kinematics, video-based kinetics) were almost absent from validated studies. Conclusions. Video-based markerless capture is not yet interchangeable with marker-based systems for clinical joint kinematics, and it remains barely validated where rehabilitation needs it most: older and pathological populations, out-of-plane kinematics, and kinetics. Mapping this evidence gap onto emerging computer-vision advances, we propose hypothesis-generating design guidelines, not a validated method, to steer the next generation of pipelines toward accessible, clinically meaningful movement analysis.
Markerless motion capture (MMC) techniques have been widely beneficial in biomechanical analysis of human movement; however, application to complex motions of the hand lags other musculoskeletal systems. The primary goal of this study was to evaluate the performance of a biomechanical reconstruction method that implements a gradient-based optimization approach with a biomechanical model in the loop for tracking dexterous, unconstrained hand movements using MMC. Using a custom, 8-camera setup, we acquired 121 video recordings from 6 participants performing 11 different tasks that spanned 6 hand postures, 5 object manipulation tasks, and involved motion of the proximal upper limb joints. Performance of the proposed MMC pipeline was directly compared to a more commonly adopted two-stage reconstruction method that first triangulates 2D keypoints from computer vision pose estimation algorithms to 3D and then enforces biomechanical constraints by solving a constrained inverse kinematics problem. Relative performance was assessed qualitatively by visual inspection and quantitatively using a computer vision metric. Our method generated solutions for all 121 video recordings; the two-stage method did not converge for 15% of the recordings. Across the remaining videos, our method produced more biomechanically plausible hand kinematics than the two-stage method and was more robust to occlusion effects during tasks that involved objects. The relative robustness of the end-to-end method suggests that it is more effective in utilizing the available 2D digital keypoint information. Automatic and biomechanically meaningful tracking of hand kinematics during dexterous movements has the potential to support clinical evaluation, rehabilitation monitoring, and studies of human motor control.
Pouyan Firouzabadi, J. D. Peiffer, Kunal Shah +4
Biomedical Engineering Department, Northwestern University, Chicago, IL, US · Shirley Ryan AbilityLab, Chicago, IL, US · Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, US +1
This paper presents a biomechanically interpretable framework for gait analysis using 3D human reconstruction from video data. Unlike conventional keypoint based approaches, the proposed method extracts biomechanically meaningful markers analogous to motion capture systems and integrates them within OpenSim for joint kinematic estimation. To evaluate performance, both spatiotemporal and kinematic gait parameters were analysed against reference marker-based data. Results indicate strong agreement with marker-based measurements, with considerable improvements when compared with pose-estimation methods alone. The proposed framework offers a scalable, markerless, and interpretable approach for accurate gait assessment, supporting broader clinical and real world deployment of vision based biomechanics
Akila Pemasiri, Ethan Goan, Glen Lichtwark +3
Queensland University of Technology, Brisbane · Griffith University, Gold Coast
The Action Research Arm Test (ARAT) is a widely-used upper limb outcome measure in neurorehabilitation, but its ordinal scoring is subjective and suffers from limited sensitivity and specificity. We evaluated whether artificial-intelligence (AI)-based markerless motion capture (MMC), embedded into ARAT assessments during clinical routine, accurately reconstructs upper limb movement and yields valid, objective kinematic metrics carrying clinically meaningful information beyond the ordinal score. Across 47 sessions from 20 mixed-neurological patients (1,174 ARAT tasks), biomechanical reconstruction was accurate and robust across impairment levels, and kinematic metrics showed the discrimination pattern expected of a construct-valid measure. In longitudinal case studies, the metrics added the specificity and sensitivity the ordinal score lacks: a domain decomposition exposed patient-specific recovery profiles underlying equal ARAT gains (specificity), and kinematic improvement continued to be detected after the ARAT had saturated (sensitivity). MMC in clinical routine can thus provide valid, objective, sensitive, and specific kinematic measurement complementing ordinal scoring.
Tim Unger, Olivier Lambercy, Roger Gassert +3
Data Analytics & Rehabilitation Technology (DART), Lake Lucerne Institute, Vitznau, Switzerland · Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland · Lake Lucerne Institute, Vitznau, Switzerland +2