The use of inertial measurement units (IMUs) has gained popularity for the estimation of lower limb kinematics. However, implementations in clinical practice are still lacking. The aim of this review is twofold-to evaluate the methodological requirements for IMU-based joint kinematic estimation to be applicable in a clinical setting, and to suggest future research directions. Studies within the PubMed, Web Of Science and EMBASE databases were screened for eligibility, based on the following inclusion criteria: (1) studies must include a methodological description of how kinematic variables were obtained for the lower limb, (2) kinematic data must have been acquired by means of IMUs, (3) studies must have validated the implemented method against a golden standard reference system. Information on study characteristics, signal processing characteristics and study results was assessed and discussed. This review shows that methods for lower limb joint kinematics are inherently application dependent. Sensor restrictions are generally compensated with biomechanically inspired assumptions and prior information. Awareness of the possible adaptations in the IMU-based kinematic estimates by incorporating such prior information and assumptions is necessary, before drawing clinical decisions. Future research should focus on alternative validation methods, subject-specific IMU-based biomechanical joint models and disturbed movement patterns in real-world settings.@en

The ability to capture joint kinematics in outside-laboratory environments is clinically relevant. In order to estimate kinematics, inertial measurement units can be attached to body segments and their absolute orientations can be estimated. However, the heading part of such orientation estimates is known to drift over time, resulting in drifting joint kinematics. This study proposes a novel joint kinematic estimation method that tightly incorporates the connection between adjacent segments within a sensor fusion algorithm, to obtain drift-free joint kinematics. Drift in the joint kinematics is eliminated solely by utilizing common information in the accelerometer and gyroscope measurements of sensors placed on connecting segments. Both an optimization-based smoothing and a filtering approach were implemented. Validity was assessed on a robotic manipulator under varying measurement durations and movement excitations. Standard deviations of the estimated relative sensor orientations were below 0.89° in an optimization-based smoothing implementation for all robot trials. The filtering implementation yielded similar results after convergence. The method is proven to be applicable in biomechanics, with a prolonged gait trial of 7 minutes on 11 healthy subjects. Three-dimensional knee joint angles were estimated, with mean RMS errors of 2.14°, 1.85°, 3.66° in an optimization-based smoothing implementation and mean RMS errors of 3.08°, 2.42°, 4.47° in a filtering implementation, with respect to a golden standard optical motion capture reference system.@en

A major shortcoming in kinematic estimation using skin-attached inertial sensors is the alignment of sensor-embedded and segment-embedded coordinate systems. Only a correct alignment results in clinically relevant kinematics. Model-based inertial-sensor-to-bone alignment methods relate inertial sensor measurements with a model of the joint. Therefore, they do not rely on properly executed calibration movements or a correct sensor placement. However, it is unknown how accurate such model-based methods align the sensor axes and the underlying segment-embedded axes, as defined by clinical definitions. Also, validation of the alignment models is challenging, since an optical motion capture ground truth can be prone to disturbances from soft tissue movement, orientation estimation and manual palpation errors. We present an anatomical tibiofemoral ground truth on an unloaded cadaveric measurement set-up that intrinsically overcomes these disturbances. Additionally, we validate existing model-based alignment strategies. Modeling the degrees of freedom leads to the identification of rotation axes. However, there is no reason why these axes would align with the segment-embedded axes. Relative inertial-sensor orientation information and rich arbitrary movements showed to aid in identifying the underlying joint axes. The first dominant sagittal rotation axis aligned sufficiently well with the underlying segment-embedded reference. The estimated axes that relate to secondary kinematics tend to deviate from the underlying segment-embedded axes as much as their expected range of motion around the axes. In order to interpret the secondary kinematics, the alignment model should more closely match the biomechanics of the joint.@en

Skin-attached inertial sensors are increasingly used for kinematic analysis. However, their ability to measure outside-lab can only be exploited after correctly aligning the sensor axes with the underlying anatomical axes. Emerging model-based inertial-sensor-to-bone alignment methods relate inertial measurements with a model of the joint to overcome calibration movements and sensor placement assumptions. It is unclear how good such alignment methods can identify the anatomical axes. Any misalignment results in kinematic cross-talk errors, which makes model validation and the interpretation of the resulting kinematics measurements challenging. This study provides an anatomically correct ground-truth reference dataset from dynamic motions on a cadaver. In contrast with existing references, this enables a true model evaluation that overcomes influences from soft-tissue artifacts, orientation and manual palpation errors. This dataset comprises extensive dynamic movements that are recorded with multimodal measurements including trajectories of optical and virtual (via computed tomography) anatomical markers, reference kinematics, inertial measurements, transformation matrices and visualization tools. The dataset can be used either as a ground-truth reference or to advance research in inertial-sensor-to-bone-alignment.@en