Mechanical analysis of movement plays an important role in clinical management of neurological and orthopedic conditions. There has been increasing interest in performing movement analysis in real-time, to provide immediate feedback to both therapist and patient. However, such work to date has been limited to single-joint kinematics and kinetics. Here we present a software system, named human body model (HBM), to compute joint kinematics and kinetics for a full body model with 44 degrees of freedom, in real-time, and to estimate length changes and forces in 300 muscle elements. HBM was used to analyze lower extremity function during gait in 12 able-bodied subjects. Processing speed exceeded 120 samples per second on standard PC hardware. Joint angles and moments were consistent within the group, and consistent with other studies in the literature. Estimated muscle force patterns were consistent among subjects and agreed qualitatively with electromyography, to the extent that can be expected from a biomechanical model. The real-time analysis was integrated into the D-Flow system for development of custom real-time feedback applications and into the gait real-time analysis interactive lab system for gait analysis and gait retraining.Electronic supplementary materialThe online version of this article (doi:10.1007/s11517-013-1076-z) contains supplementary material, which is available to authorized users.

Oshri Even-Zohar Motek Medical B.V. (a) Leeuwarden, NL (b) Liverpool, UK (c) Tel Aviv, IL (d) San Antonio, Tx, US Figure 1: Examples of virtual reality rehabilitation systems using D-Flow. AbstractD-Flow is a software system designed for the development of interactive and immersive virtual reality applications, for the purpose of clinical research and rehabilitation. Key concept of the D-Flow software system is that the subject is regarded as an integral part of a real-time feedback loop, in which multi-sensory input devices measure the behavior of the subject, while output devices return motorsensory, visual and auditory feedback to the subject. The D-Flow software system allows an operator to define feedback strategies through a flexible and extensible application development framework, based on visual programming. We describe the requirements, architecture and design considerations of the D-Flow software system, as well as a number of applications that have been developed using D-Flow, both for clinical research and rehabilitation.

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