Clinical Gait Analysis: Characterizing Normal Gait and Pathological Deviations Due to Neurological Diseases

This study addresses the characterization of normal gait and pathological deviations induced by neurological diseases, considering knee angular kinematics in the sagittal plane. We propose an unsupervised approach based on Dynamic Time Warping (DTW) to identify different normal gait profiles (NGPs) corresponding to real cycles representing the overall behavior of healthy subjects, instead of considering an average reference, as done in the literature. The obtained NGPs are then used to measure the deviations of pathological gait cycles from normal gait with DTW. Hierarchical Clustering is applied to stratify deviations into clusters. Results show that three NGPs are necessary to finely characterize the heterogeneity of normal gait and accurately quantify pathological deviations. In particular, we automatically identify which lower limb is affected for Hemiplegic patients and characterize the severity of motor impairment for Paraplegic patients. Concerning Tetraplegic patients, different profiles appear in terms of impairment severity. These promising results are obtained by considering the raw description of gait signals. Indeed, we have shown that normalizing signals removes the temporal properties of signals, inducing a loss of dynamic information that is crucial for accurately measuring pathological deviations. Our methodology could be exploited to quantify the impact of therapies on gait rehabilitation.