J. D. Peiffer

R. James Cotton, Allison DeLillo, Anthony Cimorelli et al.

Markerless motion capture using computer vision and human pose estimation (HPE) has the potential to expand access to precise movement analysis. This could greatly benefit rehabilitation by enabling more accurate tracking of outcomes and providing more sensitive tools for research. There are numerous steps between obtaining videos to extracting accurate biomechanical results and limited research to guide many critical design decisions in these pipelines. In this work, we analyze several of these steps including the algorithm used to detect keypoints and the keypoint set, the approach to reconstructing trajectories for biomechanical inverse kinematics and optimizing the IK process. Several features we find important are: 1) using a recent algorithm trained on many datasets that produces a dense set of biomechanically-motivated keypoints, 2) using an implicit representation to reconstruct smooth, anatomically constrained marker trajectories for IK, 3) iteratively optimizing the biomechanical model to match the dense markers, 4) appropriate regularization of the IK process. Our pipeline makes it easy to obtain accurate biomechanical estimates of movement in a rehabilitation hospital.

R. James Cotton, J. D. Peiffer, Kunal Shah et al.

Markerless motion capture (MMC) is revolutionizing gait analysis in clinical settings by making it more accessible, raising the question of how to extract the most clinically meaningful information from gait data. In multiple fields ranging from image processing to natural language processing, self-supervised learning (SSL) from large amounts of unannotated data produces very effective representations for downstream tasks. However, there has only been limited use of SSL to learn effective representations of gait and movement, and it has not been applied to gait analysis with MMC. One SSL objective that has not been applied to gait is contrastive learning, which finds representations that place similar samples closer together in the learned space. If the learned similarity metric captures clinically meaningful differences, this could produce a useful representation for many downstream clinical tasks. Contrastive learning can also be combined with causal masking to predict future timesteps, which is an appealing SSL objective given the dynamical nature of gait. We applied these techniques to gait analyses performed with MMC in a rehabilitation hospital from a diverse clinical population. We find that contrastive learning on unannotated gait data learns a representation that captures clinically meaningful information. We probe this learned representation using the framework of biomarkers and show it holds promise as both a diagnostic and response biomarker, by showing it can accurately classify diagnosis from gait and is responsive to inpatient therapy, respectively. We ultimately hope these learned representations will enable predictive and prognostic gait-based biomarkers that can facilitate precision rehabilitation through greater use of MMC to quantify movement in rehabilitation.

Seth Donahue, J. D. Peiffer, R. Tyler Richardson et al.

To validate a clinically accessible approach for quantifying the Upper Extremity Reachable Workspace (UERW) using a single (monocular) camera and Artificial Intelligence (AI)-driven Markerless Motion Capture (MMC) for biomechanical analysis. Objective assessment and validation of these techniques for specific clinically oriented tasks are crucial for their adoption in clinical motion analysis. AI-driven monocular MMC reduces the barriers to adoption in the clinic and has the potential to reduce the overhead for analysis of this common clinical assessment. Nine adult participants with no impairments performed the standardized UERW task, which entails reaching targets distributed across a virtual sphere centered on the torso, with targets displayed in a VR headset. Movements were simultaneously captured using a marker-based motion capture system and a set of eight FLIR cameras. We performed monocular video analysis on two of these video camera views to compare a frontal and offset camera configurations. The frontal camera orientation demonstrated strong agreement with the marker-based reference, exhibiting a minimal mean bias of $0.61 \pm 0.12$ \% reachspace reached per octanct (mean $\pm$ standard deviation). In contrast, the offset camera view underestimated the percent workspace reached ($-5.66 \pm 0.45$ \% reachspace reached). Conclusion: The findings support the feasibility of a frontal monocular camera configuration for UERW assessment, particularly for anterior workspace evaluation where agreement with marker-based motion capture was highest. The overall performance demonstrates clinical potential for practical, single-camera assessments. This study provides the first validation of monocular MMC system for the assessment of the UERW task. By reducing technical complexity, this approach enables broader implementation of quantitative upper extremity mobility assessment.

Divya Joshi, J. D. Peiffer, Colleen Peyton et al.

arly identification of motor impairment in infancy relies on expert visual assessment of spontaneous movement, motivating the development of automated, objective alternatives. One promising approach is using computer vision, which benefits from high quality pose estimation from video. In this study, we systematically evaluated three state-of-the-art pose estimation frameworks (MeTRAbs-ACAE, SAM 3D Body, and Sapiens) on 100 videos over 13 sessions of 8 infants recorded with a multi-view markerless motion capture system. We quantified keypoint detection accuracy using reprojection error, geometric consistency, and Procrustes-aligned 3D position error, and demonstrated proof-of-concept for fitting an inverse kinematic framework to infant data. While Sapiens achieved the lowest reprojection error and highest geometric consistency of the methods evaluated (22.8 pixels and 0.82, respectively), SAM 3D Body provided the most comprehensive 3D information for kinematic reconstruction with Procrustes-aligned position errors of 19 to 28 mm. We demonstrate in a case comparison example that biomechanical models fit to SAM 3D estimates distinguish representative movement patterns in infants related to motor development, as identified by a clinical expert. Together, these findings highlight both the promise and current limitations of 3D pose estimation for infant biomechanics and establish preliminary groundwork for scalable, video-based assessment of early motor development.

Tim Unger, Arash Sal Moslehian, J. D. Peiffer et al. · eth-zurich

Marker-based Optical Motion Capture (OMC) paired with biomechanical modeling is currently considered the most precise and accurate method for measuring human movement kinematics. However, combining differentiable biomechanical modeling with Markerless Motion Capture (MMC) offers a promising approach to motion capture in clinical settings, requiring only minimal equipment, such as synchronized webcams, and minimal effort for data collection. This study compares key kinematic outcomes from biomechanically modeled MMC and OMC data in 15 stroke patients performing the drinking task, a functional task recommended for assessing upper limb movement quality. We observed a high level of agreement in kinematic trajectories between MMC and OMC, as indicated by high correlations (median r above 0.95 for the majority of kinematic trajectories) and median RMSE values ranging from 2-5 degrees for joint angles, 0.04 m/s for end-effector velocity, and 6 mm for trunk displacement. Trial-to-trial biases between OMC and MMC were consistent within participant sessions, with interquartile ranges of bias around 1-3 degrees for joint angles, 0.01 m/s in end-effector velocity, and approximately 3mm for trunk displacement. Our findings indicate that our MMC for arm tracking is approaching the accuracy of marker-based methods, supporting its potential for use in clinical settings. MMC could provide valuable insights into movement rehabilitation in stroke patients, potentially enhancing the effectiveness of rehabilitation strategies.

J. D. Peiffer, Kunal Shah, Irina Djuraskovic et al.

The way a person moves is a direct reflection of their neurological and musculoskeletal health, yet it remains one of the most underutilized vital signs in clinical practice. Although clinicians visually observe movement impairments, they lack accessible and validated methods to objectively measure movement in routine care. This gap prevents wider use of biomechanical measurements in practice, which could enable more sensitive outcome measures or earlier identification of impairment. We present our Portable Biomechanics Laboratory (PBL), which includes a secure, cloud-enabled smartphone app for data collection and a novel algorithm for fitting biomechanical models to this data. We extensively validated PBL's biomechanical measures using a large, clinically representative dataset. Next, we tested the usability and utility of our system in neurosurgery and sports medicine clinics. We found joint angle errors within 3 degrees across participants with neurological injury, lower-limb prosthesis users, pediatric inpatients, and controls. In addition to being easy to use, gait metrics computed from the PBL showed high reliability and were sensitive to clinical differences. For example, in individuals undergoing decompression surgery for cervical myelopathy, the mJOA score is a common patient-reported outcome measure; we found that PBL gait metrics correlated with mJOA scores and demonstrated greater responsiveness to surgical intervention than the patient-reported outcomes. These findings support the use of handheld smartphone video as a scalable, low-burden tool for capturing clinically meaningful biomechanical data, offering a promising path toward accessible monitoring of mobility impairments. We release the first clinically validated method for measuring whole-body kinematics from handheld smartphone video at https://intelligentsensingandrehabilitation.github.io/MonocularBiomechanics/ .