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Presently telemedicine in podiatry is in its nascent development phase. Current exploratory work indicates that a comprehensive set of guidelines regarding telemedicine in podiatry is necessary. Stakeholders have put forward multiple factors to be considered while developing guidelines to devise a sustainable service.

Vector coding is a data analysis technique that quantifies inter-segmental coordination and coordination variability of human movement. The usual reporting of vector coding time-series data can be difficult to interpret when multiple trials are superimposed on the same figure. This study describes and presents novel data visualisations for displaying data from vector coding that supports multiple single- subject analyses. The dataset used in this study describes the lumbar-pelvis coordination in the transverse plane during a gait cycle. The data visualisation techniques presented in this study consists of the use of colour and data bars to map and profile coordination pattern and coordination variability data. The use of colour mapping provides the option to classify commonalities and differences in patterns of coordination between segment couplings and between individuals across a big dataset. Data bars display segmental dominancy data that can provide an intuitive summary on coupling angle distribution over time. The data visualisation in this study may provide further insight on how people with adolescent idiopathic scoliosis perform goal-orientated movements following an intervention, which would support clinical management strategies.

For many patients, the motivation in seeking treatment is the improvement of their appearance rather than to correct an underlying skeletal deformity, so cosmetic concerns and the psychosocial impacts of adolescent idiopathic scoliosis are important factors in the clinical decision-making process. In the current environment of evidence based medicine there is a growing need to quantify back surface shape and general body asymmetry with the objective of producing an agreed scoring to be used in developing treatment plans and assessing outcomes but to date many clinics continue to rely on qualitative or expensive methods to describe cosmetic deformity. In November 2010, Microsoft® Corporation launched the low cost Kinect™ camera with 18 million units sold (as at January 2012) throughout the world. The device incorporates proprietary light coding technology that reconstructs the three dimensional location of an estimated 50,000 projected points illuminating objects within its field of view in approximately 1/30th of a second. The aim of the research was to investigate the capabilities of a low cost, reliable and inherently safe apparatus based on Kinect depth sensing and video technology to simultaneously acquire back surface shape and the locations of bony landmarks with the goal of providing data to describe cosmetic defect. Work has been completed using both the apparatus and a commercially available optical motion capture system (Vicon Motion Systems, Oxford, U.K.) to acquire data from a test object representing an unaffected human torso. Results were obtained to compare tri-dimensional bony landmark reconstruction accuracy and combined with analyses of point cloud data to describe back shape. Early indications are that the proposed apparatus has potential to be a clinically useful tool.

Optoelectronic motion capture technology is a useful tool in the quantitative dynamic assessment of the spine. In a clinical setting this may help gain a further understanding of underlining musculoskeletal pathology. It is therefore important that accurate measurements are made to allow data to be comparable across various investigations. This report outlines a new multi-segment spinal model and its validation. A mechanical model consisting of an upper thoracic (UT), lower thoracic and lumbar segment was developed allowing for range of motion assessment. An electrogoniometer and torsiometer were attached to the model to provide a control measurement. The UT segment was chosen for analysis and static trials were collected at angles ranging from 2-45°. Kinematic data was captured using an optoelectronic motion capture system. Software computed angles corresponded well with the control measure. While highlighting the differences in the estimation of angles between software platforms, this study emphasizes the need for the clear description and understanding of the kinematic model used.

There are assumptions that leg length discrepancy (LLD) may cause low back pain by creating pelvis obliquity and lumbar scoliosis. Although individuals with LLD develop compensatory movements in the lower limbs and pelvis during walking, few investigations have attempted to identify kinematic variables of the upper body. This study aims to gain an understanding of how simulated LLD influences three-dimensional motion of the pelvis and spine. Seven male participants were required to walk barefoot at a preferred speed. Three LLD conditions (1, 2, and 3cm) were simulated using modified pieces of high density EVA attached to the right foot. An optoelectronic motion analysis system was used to record kinematic data of the pelvis and spine (lumbar, lower and upper thoracic segments) for each condition. Differences in range of motion and patterns of movement for the pelvis and lumbar spine were minimal between barefoot and LLD conditions. These observations could be attributed to various kinematic compensatory strategies within the lower limbs which require further in-depth investigation.

Healthcare professionals frequently evaluate spinal posture on visual assessment during the clinical examination. While this visual assessment of the spine has been shown to be unreliable, the use of a plumbline as to aid clinical visual assessment has also been reported. There is a "normal" sagittal contour that functions quite well in healthy people. It positions the head in space, it protects the neural axis, and it allows efficient, pain-free motion. Lumbar lordosis is routinely evaluated in most spine patients, but what constitutes a normal sagittal contour is less well defined. A key component of normal sagittal contour is lumbar lordosis. Changes in the lumbar lordosis frequently occur in pathological gait, usually in association with alterations in pelvic tilt, and commonly as a compensation for a limited range of flexion/extension at the hip joint. Recent investigations looked at the effect of hyperpronation on pelvic alignment in a standing position and supported the existence of a kinematic chain in healthy subjects, where hyperpronation can lead to an immediate shank and thigh internal rotation and change in pelvic position. While there is a wealth of research is available on the effectiveness of functional foot orthoses, the present investigation reports the effect of pronated foot position on the lumbar region of the back by employing an optoelectronic movement analysis system.

Optoelectronic movement analysis systems has provided an opportunity for a detailed study of both normal and abnormal human walking and has contributed to the planning and documentation of corrective surgical procedures. The majority of reported studies have been on the study of lower limbs which, consequently, have received most attention in movement analysis. In contrast, movement of the trunk and pelvis, important in the identification of spinal mobility and maintaining posture, have received limited attention in relation to clinical conditions such as scoliosis. Any movement analysis requires the identification of anatomical landmarks which are essential contributing factors to the accuracy of the analysis. While there are a plethora of studies on marker placements for the lower limbs, there is a paucity of information on the marker locations for spinal analysis. Present study examines a set of markers previously reported in the literature and examines their usefulness in scoliotic gait analysis. The findings highlight the drawbacks in previously reported techniques and leads to the proposal of a new marker set for spine and back movement analysis.

Previous research employing biomechanical measurement has demonstrated asymmetries in kinematics and kinetics. Similar asymmetries have been reported from anthropometric studies. These findings suggest that asymmetry may play an important aetiological role in adolescent idiopathic scoliosis (AIS). The present study is a part of a wider comprehensive investigation aimed at identifying asymmetries in lower limb kinematics and pelvic and back movements during level walking in a sample of scoliotic subjects. Such asymmetries may be related to the spinal deformity. While previous studies indicate that force platform measurements provide a good estimation of the static balance of individuals, there remains a paucity of information on dynamic balance during walking. There is published evidence on the use of Centre of Pressure (CoP) and net joint moments in gait assessment. Although these investigations have assessed Centre of Mass (CoM)-CoP distance relationships in clinical conditions, there is a paucity of data relating to the moments about CoM. An objective of the present study was to assess and establish the asymmetry in the CoP pattern and moments about CoM during level walking and its relationship to spinal deformity. Results indicate differences across the subjects depending on the laterality of the major curve. Furthermore, the results indicate that the variables identified in this study could be applied to initial screening and surgical evaluation of scoliosis and other spinal deformities. Further studies are being undertaken to validate these findings.

In a clinical setting, most musculoskeletal assessment related to gait is undertaken using a treadmill which is additionally widely used during gait and neurological rehabilitation. Although previous studies have reported the range of motion of gait characteristics during running, there is a paucity of information on normative walking data applicable to clinical assessment. Movements and posture of the shoulder girdle is an important indication of back and upper extremity function. While studies indicate that shoulder girdle kinematics are changed during shoulder dysfunction there is little information on the postural relationship between the shoulder and pelvis. The present investigation aims to create a normative database for kinematics during treadmill walking by examining the differences between the treadmill and over ground walking patterns. Additionally, the research will also assess shoulder girdle posture and to establish its relationship with the pelvic complex which will contribute to further understanding scoliotic posture and movement. 14 normal subjects walked over ground at a self-selected speed followed by walking on the treadmill at a speed matched to each subject's respective average over-ground speed. Three-dimensional kinematic data was captured using a passive marker based motion analysis system (Vicon Peak, UK). Angular and temporal kinematic parameters were estimated. The results indicate differences in angular kinematics between over-ground and treadmill locomotion. These differences should be considered when treadmill kinematics are used for clinical evaluation as opposed to over ground ambulation is scoliosis and other conditions.

The importance of trunk movement in human gait has been established by many studies. However, these investigations have examined trunk/pelvis motion or the pelvic/thoracic motion in isolation to lower limb kinematics. Studies quantifying spinal deformities and the range of spinal and trunkal movement have concentrated on spinal/back movement, with the subject performing tasks, such as flexion, while maintaining a static position. There is also a paucity of data detailing the real relative motion between the back and lower limb during gait, an important consideration when testing the Nottingham 'flag-pole' hypothesis for spinal curvature generation. Research into the use of opto-electronic gait analysis systems to measure dynamic back movements has shown the capability of these systems in producing repeatable patterns of back movements. While using a motion analysis system, if a relationship between the spinal movement and lower limb kinematics could be established, such a relationship would provide a new opportunity for range of movement studies in conditions like scoliosis. Furthermore, establishing such a relationship would allow investigation into the influence of one segment over another during locomotion. This present study has examined the movement of markers placed on the back and pelvis, used in three-dimensional opto-electronic systems for gait studies, in relation to the markers placed on the lower limbs. The results of a pilot study have highlighted relative movements between various segments in simple tasks like flexion, lateral bending and negotiating steps, which have implications for spinal deformity generation. The findings also demonstrate the points to be considered in order to define dynamic trunk and spinal movement. Further ongoing studies are being undertaken to validate the findings.

Although various factors have been attributed to the etiology of idiopathic scoliosis, studies have indicated that the kinematic differences in the spine, pelvis and lower limb may contribute to the causation and progression of idiopathic scoliosis. The aim of this investigation was to identify asymmetries in lower limb kinematics and pelvic and back movements during level walking in scoliotic subjects that can be related to the spinal deformity. The study has employed a movement analysis system to estimate various joint angles in the lower extremities and other kinematic parameters in the pelvis and back. The results of a pilot study have highlighted the potential usefulness of a range of parameters in the indication of asymmetries and their implications for spinal deformity generation. While demonstrating the value that movement analysis systems may have in investigating pathogenesis and aetiology, these preliminary findings indicate that the identified variables can also used in the kinematic analysis of spinal deformities such as scoliosis. Further studies are being undertaken to validate these findings.

An attempt has been made to simplify the measurement of composite movement involving abnormal rotation in scoliosis, which is considered to have an important role in the diagnosis and treatment of the condition. Analysis of three-dimensional movement provides pertinent information concerning the morphological description of scoliotic deformities. The description of this movement is of clinical interest for aiding diagnosis and/or prognosis of spinal deformity evolution. Previous studies have indicated that idiopathic scoliosis is a three-dimensional deformity accompanied by a generalised torsion phenomenon and attempts have been made to associate the geometric torsion index with the curvi-linear shape of idiopathic scoliosis. Although previous investigations have documented the three-dimensional reconstruction of scoliotic spine, most methods either expose the subject to a high level of radiation, as in stereo-radiographs, or demand a high degree of technical input and time, as in video based gait analysis systems. This study employs an electro magnetic field capturing system (FASTRAK) to estimate the spinal movements. This simple system is inexpensive and highly portable. Furthermore, it can give instant graphic and numerical values of the composite movement. The results of this study indicate the usefulness this system in the diagnosis of scoliosis and highlights the possibility of its uses in screening school children and other surveys.

Various investigations into anatomical landmarks that could be employed in spine and back surface measurement have highlighted the usefulness of the spinous processes of the vertebra and the posterior superior iliac spines of the pelvis. Earlier studies used an opto-electronic gait analysis system to examine the motion of skin markers and compared results with similar inter-vertebral movement recorded through radiographs. Consistent patterns of movement suggested a relationship between spinal and back surface motion. Further investigations into the use of opto-electronic gait analysis systems to measure dynamic back movements showed the capability of producing repeatable patterns of back movements. However, these studies, mainly measuring the range of movement (ROM) of spine, have not examined the effects of marker placements. While most ROM studies concentrate on stationary repetitive flexion/extension and bending movements, spinal ROM during walking and in scoliosis has not been widely reported. Spinal range of motion is an important indicator of spinal function and is used in the determination of disability and compensation. The present study has evaluated the placement of markers on the back and pelvis, used in three-dimensional opto-electronic systems for gait and movement studies. Various marker configurations have been compared and reported. The findings highlight the drawbacks of previously reported techniques, and particularly indicate that skin movement can adversely affect findings. However, the results confirm the feasibility of application of this technique to investigate dynamic trunk and spinal movement in both normal and deformed spines.