Monocular markerless biomechanics for clinically interpretable gait assessment in spinal cord injury

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.

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.

Kinematic monitoring plays a critical role in long-term rehabilitation for patients with spinal cord injury (SCI), where multi-view markerless motion capture methods have shown significant potential. However, owing to the reliance on calibration and the difficulty of achieving multi-view synchronization, their deployment in patient self-deployed environments remains challenging. In this work, we propose an agentic pipeline for self-synchronized multi-view joint angle monitoring in uncalibrated environments using two cameras without hardware triggers. The Multimodal large language models enable automatic video synchronization and agent-driven self-verification. State-of-the-art monocular 2D pose estimation models are employed to extract candidate poses, where an agent-based selection mechanism is then applied to automatically identify and track the target subject, thereby producing consistent 2D poses in the presence of multiple individuals and occlusions. Such 2D poses are optimized to estimate joint angles from uncalibrated multi-view pose sequences, ensuring interpretability through explicit geometric modeling. Validation against Vicon system demonstrated the strong performance, achieving an MAE of $5.97^\circ \pm 2.36^\circ$ and a Pearson correlation coefficient of $0.962 \pm 0.014$. The proposed method is expected to provide a practical, patient self-deployable system to perform daily kinematic monitoring in uncalibrated home environments.