Gait Analysis

Gait analysis provides an objective characterization of locomotor function and is widely used to support diagnosis and rehabilitation monitoring across neurological and orthopedic disorders. Deep learning has been increasingly applied to this domain, yet most approaches rely on supervised classifiers trained on disease-labeled data, limiting generalization to heterogeneous pathological presentations. The methodological objective of this work is to develop a label-free framework for joint-level anomaly detection and kinematic correction based on a Transformer masked autoencoder trained exclusively on normative gait sequences from 150 adults, acquired with a markerless multi-camera motion-capture system. At inference, a two-pass procedure is applied to potentially pathological input sequences: first, it estimates joint inconsistency scores by occluding individual joints and measuring deviations from the learned normative prior. Then, it withholds the flagged joints from the encoder input and reconstructs the full skeleton from the remaining spatiotemporal context, yielding corrected kinematic trajectories at the flagged positions. The validation objective is to assess whether the framework preserves unseen normative gait and reduces angular deviation in simulated abnormal gait patterns. In this proof-of-concept evaluation, data from 10 held-out normative participants, who performed seven simulated abnormal gait patterns, showed a significant reduction in angular deviation across all analyzed joints with large effect sizes, and preservation of normative kinematics. The proposed approach enables interpretable, subject-specific localization of joints that are inconsistent with learned normative gait patterns and generation of an individualized normative reconstruction without requiring disease labels. Video is available at https://youtu.be/Rcm3jqR5pN4.

Gait is increasingly recognized as a vital sign, yet current approaches treat it as a symptom of specific pathologies rather than a systemic biomarker. We developed a gait foundation model for 3D skeletal motion from 3,414 deeply phenotyped adults, recorded via a depth camera during five motor tasks. Learned embeddings outperformed engineered features, predicting age (Pearson r = 0.69), BMI (r = 0.90), and visceral adipose tissue area (r = 0.82). Embeddings significantly predicted 1,980 of 3,210 phenotypic targets; after adjustment for age, BMI, VAT, and height, gait provided independent gains in all 18 body systems in males and 17 of 18 in females, and improved prediction of clinical diagnoses and medication use. Anatomical ablation revealed that legs dominated metabolic and frailty predictions while torso encoded sleep and lifestyle phenotypes. These findings establish gait as an independent multi-system biosignal, motivating translation to consumer-grade video and its integration as a scalable, passive vital sign.

Frailty is a condition in aging medicine characterized by diminished physiological reserve and increased vulnerability to stressors. However, frailty assessment remains subjective, heterogeneous, and difficult to scale in clinical practice. Gait is a sensitive marker of biological aging, capturing multisystem decline before overt disability. Yet the application of modern computer vision to gait-based frailty assessment has been limited by small, imbalanced datasets and a lack of clinically representative benchmarks. In this work, we introduce a publicly available silhouette-based frailty gait dataset collected in a clinically realistic setting, spanning the full frailty spectrum and including older adults who use walking aids. Using this dataset, we evaluate how pretrained gait recognition models can be adapted for frailty classification under limited data conditions. We study both convolutional and hybrid attention-based architectures and show that predictive performance depends primarily on how pretrained representations are transferred rather than architectural complexity alone. Across models, selectively freezing low-level gait representations while allowing higher-level features to adapt yields more stable and generalizable performance than either full fine-tuning or rigid freezing. Conservative handling of class imbalance further improves training stability, and combining complementary learning objectives enhances discrimination between clinically adjacent frailty states. Interpretability analyses reveal consistent model attention to lower-limb and pelvic regions, aligning with established biomechanical correlates of frailty. Together, these findings establish gait-based representation learning as a scalable, non-invasive, and interpretable framework for frailty assessment and support the integration of modern biometric modeling approaches into aging research and clinical practice.

Pathological gait analysis is constrained by limited and variable clinical datasets, which restrict the modeling of diverse gait impairments. To address this challenge, we propose a Pathological Gait-conditioned Generative Adversarial Network (PGcGAN) that synthesises pathology-specific gait sequences directly from observed 3D pose keypoint trajectories data. The framework incorporates one-hot encoded pathology labels within both the generator and discriminator, enabling controlled synthesis across six gait categories. The generator adopts a conditional autoencoder architecture trained with adversarial and reconstruction objectives to preserve structural and temporal gait characteristics. Experiments on the Pathological Gait Dataset demonstrate strong alignment between real and synthetic sequences through PCA and t-SNE analyses, visual kinematic inspection, and downstream classification tasks. Augmenting real data with synthetic sequences improved pathological gait recognition across GRU, LSTM, and CNN models, indicating that pathology-conditioned gait synthesis can effectively support data augmentation in pathological gait analysis.

Motion imitation learning (IL) is increasingly used in robotics and human gait modeling, yet its ability to recover biomechanically consistent joint moments without explicit kinetic information remains unclear. In this study, we examined whether motion imitation alone can estimate reasonable biological joint moments. We compare motion-only IL (MOIL) against a kinetics-aware IL (KAIL) framework that incorporates ground reaction forces (GRF) and center of pressure (CoP) in imitation rewards, with an ablation study to examine the contribution of each kinetic term. Experiments were conducted using walking data from a non-disabled participant at three speeds (0.9, 1.2, and 1.5 m/s). While both MOIL and KAIL achieved comparable kinematic tracking accuracy, MOIL exhibited substantially larger errors in GRF, CoP, and joint moment estimates relative to inverse dynamics references. In contrast, KAIL produced kinetics more consistent with biomechanical values. These findings highlight a fundamental limitation of MOIL approaches, which may lead to erroneous interpretations of gait biomechanics and downstream applications by failing to estimate consistent human-like gait kinetics.

Video-based Clinical Gait Analysis often suffers from poor generalization as models overfit environmental biases instead of capturing pathological motion. To address this, we propose BioGait-VLM, a tri-modal Vision-Language-Biomechanics framework for interpretable clinical gait assessment. Unlike standard video encoders, our architecture incorporates a Temporal Evidence Distillation branch to capture rhythmic dynamics and a Biomechanical Tokenization branch that projects 3D skeleton sequences into language-aligned semantic tokens. This enables the model to explicitly reason about joint mechanics independent of visual shortcuts. To ensure rigorous benchmarking, we augment the public GAVD dataset with a high-fidelity Degenerative Cervical Myelopathy (DCM) cohort to form a unified 8-class taxonomy, establishing a strict subject-disjoint protocol to prevent data leakage. Under this setting, BioGait-VLM achieves state-of-the-art recognition accuracy. Furthermore, a blinded expert study confirms that biomechanical tokens significantly improve clinical plausibility and evidence grounding, offering a path toward transparent, privacy-enhanced gait assessment.

Differential diagnosis among parkinsonian syndromes remains a clinical challenge due to overlapping motor symptoms and subtle gait abnormalities. Accurate differentiation is crucial for treatment planning and prognosis. While gait analysis is a well established approach for assessing motor impairments, conventional methods often overlook hidden nonlinear and structural features embedded in foot clearance patterns. We evaluated Topological Data Analysis (TDA) as a complementary tool for Parkinsonism classification using foot clearance time series. Persistent homology produced Betti curves, persistence landscapes, and silhouettes, which were used as features for a Random Forest classifier. The dataset comprised 15 controls (CO), 15 idiopathic Parkinson's disease (IPD), and 14 vascular Parkinsonism (VaP). Models were assessed with leave-one-out cross-validation (LOOCV). Betti-curve descriptors consistently yielded the strongest results. For IPD vs VaP, foot clearance variables minimum toe clearance, maximum toe late swing, and maximum heel clearance achieved 83% accuracy and AUC=0.89 under LOOCV in the medicated (On) state. Performance improved in the On state and further when both Off and On states were considered, indicating sensitivity of the topological features to levodopa related gait changes. These findings support integrating TDA with machine learning to improve clinical gait analysis and aid differential diagnosis across parkinsonian disorders.

Background: Machine learning (ML) enhances gait analysis but often lacks the level of interpretability desired for clinical adoption. Large Language Models (LLMs) may offer explanatory capabilities and confidence-aware outputs when applied to structured kinematic data. This study therefore evaluated whether general-purpose LLMs can classify continuous gait kinematics when represented as textual numeric sequences and how their performance compares to conventional ML approaches. Methods: Lower-body kinematics were recorded from 20 participants performing seven gait patterns. A supervised KNN classifier and a class-independent One-Class SVM (OCSVM) were compared against zero-shot LLMs (GPT-5, GPT-5-mini, GPT-4.1, and o4-mini). Models were evaluated using Leave-One-Subject-Out (LOSO) cross-validation. LLMs were tested both with and without explicit reference gait statistics. Results: The supervised KNN achieved the highest performance (multiclass Matthews Correlation Coefficient, MCC = 0.88). The best-performing LLM (GPT-5) with reference grounding achieved a multiclass MCC of 0.70 and a binary MCC of 0.68, outperforming the class-independent OCSVM (binary MCC = 0.60). Performance of the LLM was highly dependent on explicit reference information and self-rated confidence; when restricted to high-confidence predictions, multiclass MCC increased to 0.83 on the filtered subset. Notably, the computationally efficient o4-mini model performed comparably to larger models. Conclusion: When continuous kinematic waveforms were encoded as textual numeric tokens, general-purpose LLMs, even with reference grounding, did not match supervised multiclass classifiers for precise gait classification and are better regarded as exploratory systems requiring cautious, human-guided interpretation rather than diagnostic use.

Freezing of Gait (FOG) is a debilitating motor symptom commonly experienced by individuals with Parkinson's Disease (PD) which often leads to falls and reduced mobility. Timely and accurate prediction of FOG episodes is essential for enabling proactive interventions through assistive technologies. This study presents a reinforcement learning-based framework designed to identify optimal pre-FOG onset points, thereby extending the prediction horizon for anticipatory cueing systems. The model implements a Double Deep Q-Network (DDQN) architecture enhanced with Prioritized Experience Replay (PER) allowing the agent to focus learning on high-impact experiences and refine its policy. Trained over 9000 episodes with a reward shaping strategy that promotes cautious decision-making, the agent demonstrated robust performance in both subject-dependent and subject-independent evaluations. The model achieved a prediction horizon of up to 8.72 seconds prior to FOG onset in subject-independent scenarios and 7.89 seconds in subject-dependent settings. These results highlight the model's potential for integration into wearable assistive devices, offering timely and personalized interventions to mitigate FOG in PD patients.

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

It remains challenging to achieve human-like locomotion in legged robots due to fundamental discrepancies between biological and mechanical structures. Although imitation learning has emerged as a promising approach for generating natural robotic movements, simply replicating joint angle trajectories fails to capture the underlying principles of human motion. This study proposes a Gait Divergence Analysis Framework (GDAF), a unified biomechanical evaluation framework that systematically quantifies kinematic and kinetic discrepancies between humans and bipedal robots. We apply GDAF to systematically compare human and humanoid locomotion across 28 walking speeds. To enable reproducible analysis, we collect and release a speed-continuous humanoid locomotion dataset from a state-of-the-art humanoid controller. We further provide an open-source implementation of GDAF, including analysis, visualization, and MuJoCo-based tools, enabling quantitative, interpretable, and reproducible biomechanical analysis of humanoid locomotion. Results demonstrate that despite visually human-like motion generated by modern humanoid controllers, significant biomechanical divergence persists across speeds. Robots exhibit systematic deviations in gait symmetry, energy distribution, and joint coordination, indicating that substantial room remains for improving the biomechanical fidelity and energetic efficiency of humanoid locomotion. This work provides a quantitative benchmark for evaluating humanoid locomotion and offers data and versatile tools to support the development of more human-like and energetically efficient locomotion controllers. The data and code will be made publicly available upon acceptance of the paper.

Instrumented Timed Up and Go (TUG) analysis can support clinical and research decision-making, but robust and reproducible markerless pipelines are still limited. We present tugturn.py, a Python-based workflow for 3D markerless TUG processing that combines phase segmentation, gait-event detection, spatiotemporal metrics, intersegmental coordination, and dynamic stability analysis. The pipeline uses spatial thresholds to segment each trial into stand, first gait, turning, second gait, and sit phases, and applies a relative-distance strategy to detect heel-strike and toe-off events within valid gait windows. In addition to conventional kinematics, tugturn provides Vector Coding outputs and Extrapolated Center of Mass (XCoM)-based metrics. The software is configured through TOML files and produces reproducible artifacts, including HTML reports, CSV tables, and quality-assurance visual outputs. A complete runnable example is provided with test data and command-line instructions. This manuscript describes the implementation, outputs, and reproducibility workflow of tugturn as a focused software contribution for markerless biomechanical TUG analysis.

Unilateral muscle weakness often leads to asymmetric gait, disrupting interlimb coordination and stance timing. This study presents a reinforcement learning (RL) based musculoskeletal simulation framework to (1) quantify how progressive unilateral muscle weakness affects gait symmetry and (2) evaluate whether ankle exoskeleton assistance can improve gait symmetry under impaired conditions. The overarching goal is to establish a simulation- and learning-based workflow that supports early controller development prior to patient experiments. Asymmetric gait was induced by reducing right-leg muscle strength to 75%, 50%, and 25% of baseline. Gait asymmetry was quantified using toe-off timing, peak contact forces, and joint-level symmetry metrics. Increasing weakness produced progressively larger temporal and kinematic asymmetry, most pronounced at the ankle. Ankle range of motion symmetry degraded from near-symmetric behavior at 100% strength (symmetry index, SI = +6.4%; correlation r=0.974) to severe asymmetry at 25% strength (SI = -47.1%, r=0.889), accompanied by a load shift toward the unimpaired limb. At 50% strength, ankle exoskeleton assistance improved kinematic symmetry relative to the unassisted impaired condition, reducing the magnitude of ankle SI from 25.8% to 18.5% and increasing ankle correlation from r=0.948 to 0.966, although peak loading remained biased toward the unimpaired side. Overall, this framework supports controlled evaluation of impairment severity and assistive strategies, and provides a basis for future validation in human experiments.

Accurate gait event detection is crucial for gait analysis, rehabilitation, and assistive technology, particularly in exoskeleton control, where precise identification of stance and swing phases is essential. This study evaluated the performance of seven kinematics-based methods and a Long Short-Term Memory (LSTM) model for detecting heel strike and toe-off events across 4363 gait cycles from 588 able-bodied subjects. The results indicated that while the Zeni et al. method achieved the highest accuracy among kinematics-based approaches, other methods exhibited systematic biases or required dataset-specific tuning. The LSTM model performed comparably to Zeni et al., providing a data-driven alternative without systematic bias. These findings highlight the potential of deep learning-based approaches for gait event detection while emphasizing the need for further validation in clinical populations and across diverse gait conditions. Future research will explore the generalizability of these methods in pathological populations, such as individuals with post-stroke conditions and knee osteoarthritis, as well as their robustness across varied gait conditions and data collection settings to enhance their applicability in rehabilitation and exoskeleton control.

Freezing of gait (FOG) is a debilitating feature of Parkinson's disease (PD) and a common cause of injurious falls. Recent advances in wearable-based human activity recognition (HAR) have enabled FOG detection, but bias and fairness in these models remain understudied. Bias is defined as a systematic error leading to unequal outcomes, while fairness refers to consistent performance across subject groups. Biased models could systematically underserve patients with specific FOG phenotypes or demographics, widening care disparities. We evaluated the bias and fairness of state-of-the-art HAR models for FOG detection across FOG phenotypes and patient demographics using 4 public wearable datasets (145 subjects and 59.8 hours of recording) with multiple on-body sensor locations and temporal annotations on FOG episodes across various behavioral test protocols. Four mitigation approaches were assessed: conventional methods (threshold optimization and adversarial debiasing) and two transfer learning-based approaches (multi-site transfer and fine-tuning pre-trained models). Fairness was primarily quantified using the demographic parity ratio (DPR) and the equalized odds ratio (EOR). HAR models exhibited substantial bias (DPR & EOR < 0.8) across age, sex, disease duration, and critically, FOG phenotype. This phenotype-specific bias is particularly concerning as tremulous and akinetic FOG may require different clinical management. Conventional methods failed: threshold optimization (DPR=-0.126, EOR=+0.063) and adversarial debiasing (DPR=-0.008, EOR=-0.001). In contrast, multi-site transfer learning improved fairness (DPR=+0.037, p<0.01; EOR=+0.045, p<0.01) and performance (F1-score=+0.020, p<0.05), though neither metric reached 0.8. Transfer learning across diverse datasets may partially mitigate these disparities, helping wearable-based FOG monitoring benefit all individuals with PD.