Fullin, Allegra (2025) Development and Validation of a Novel and Comprehensive Whole-Body Marker Set for Motion Analysis: Characterization of Sagittal Alignment in Standing, Quantitative Assessment of Sagittal Kinematics of Gait and Functional Movements, in Healthy and Pathological Populations. [Tesi di dottorato]

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Abstract

Understanding human movement is fundamental to both clinical practice and scientific research. The complex interplay of musculoskeletal and neurological systems dictates how we stand, walk, and perform daily activities. Three-dimensional (3D) gait analysis is a cornerstone in understanding human movement, crucial for both clinical diagnostics and research. However, existing marker placement protocols often lack a comprehensive, "whole-body" approach, particularly in characterizing posture and kinematics on sagittal plane by integrating upper limbs, lower limbs, and a multi-segmental trunk model, alongside head movements. This limitation constrains a holistic understanding of compensatory strategies and the complex interplay between body segments in various conditions, and makes the quantitative evaluation of upright posture challenging. The present doctoral thesis addresses this critical gap by developing and validating a novel "whole-body" marker placement protocol for 3D gait analysis, the DB-Total protocol, specifically designed for a detailed sagittal plane assessment across several movement domains. The new protocol introduces innovative parameters that provide a richer description of sagittal alignment, extending beyond traditional lower limb focus to encompass the entire kinematic chain, including a detailed kinematic evaluation of the sagittal spine.The protocol is developed and undergoes rigorous validation, using correlation with gold standard methodologies. This robust procedure ensures its accuracy and clinical applicability. A primary application of this validated protocol is to establish normative values for sagittal upright standing posture on sagittal plane in healthy subjects, providing a crucial reference for clinical interpretation of postural abnormalities. Subsequently, the protocol is extensively used to characterize normative sagittal kinematics and to assess specific sagittal kinematic patterns, within various pathological populations, identifying their adaptations. Furthermore, the study investigates the short and longterm effects of therapeutic interventions, such as orthoses and pharmacological treatments. Finally, the versatility of this protocol is demonstrated through its application to characterize the kinematics of other functional movements, such as the Sit-to-Stand (STS), providing preliminary data in healthy individuals and its future application in pathological cohorts. This comprehensive approach underscores the potential of the "whole-body" protocol for a holistic and versatile movement assessment.

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