Technology Overview:
The Gait Analysis Laboratory
Gyusung Lee, MS
Biomedical Engineering Program
Texas A&M University
College Station, Texas

Fabian E. Pollo, PhD
Motion and Performance Laboratory
Baylor University Medical Center
Dallas, Texas

The main purpose of gait analysis laboratories is to measure and study human gait walking patterns in order to better
understand and treat gait abnormalities. Gait analysis involves the measurement of kinetics/kinematics of joint movement, muscular activity, stride characteristics, pedobarography, and energy consumption. Kinetic data are measured with
a force platform that provides information about ground reaction forces and when combined with kinematic data, can
yield joint forces and moments. Joint angle and limb segment motion data or kinematic data are obtained by motion
analysis systems such as electrogoniometers or photographic systems. Electromyography is used to identify muscle timing and relative muscle intensity. Stride characteristics are used to measure gait timing events. Pedobarography deals with
plantar pressure under the foot and the efficiency of gait can be measured with oxygen consumption analysis. Gait
analysis is useful for research on normal and abnormal walking patterns, gaining a better understanding of a subject’s gait,
and planning treatment strategy.
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d: Gait Analysis, Gait Laboratories, Motion Analysis



here are two groups of people who are particularly
interested in the dynamics of human motion.1 The
first group includes athletes, coaches and trainers of
athletes. They want to optimize performance and avoid injury through the detailed examination and enhancement of
human movement.The second group includes clinicians and
medical research personnel (e.g., physicians and therapists).
They try to identify the underlying etiology of movement
abnormalities so that proper corrective measures may be
taken. In addition, they also undertake research aimed at
increasing the understanding of normal and pathological
movement patterns. Both groups seek to enhance human
movement, but with two different perspectives. One particular area in the study of human motion is gait analysis.
The gait analysis laboratory has become an increasingly
common resource in hospitals specializing in orthopedics
and movement disorders. There is also a journal (Gait and
Posture) and a society (Gait and Clinical Movement Analysis Society) devoted to gait and motion analysis.
Human walking is a result of a complex process involving the brain, spinal cord, peripheral nerves, muscles, bones

and joints.2 Gait represents the manner or style of walking,
and gait analysis refers to a process in which kinematic and
kinetic data are measured, calculated, and then analyzed to
provide information that describes the events. In clinical
applications, this interpretation provides information used
to form assessments of a patient’s particular gait abnormality.1 Gait analysis helps in the medical management of abnormal gait by providing guidance for therapy, surgery, and
prosthetics. These laboratories also support research such
as quantitative studies of the relative effectiveness of alternative interventions. Modern gait analysis laboratories utilize various measurement systems to acquire and analyze
joint motion (kinematics), forces (kinetics), and muscular
activity and there are several choices for each technique
(See Table 1). In this paper, a brief history of gait analysis,
current measurement systems and techniques, and applications of acquired data are discussed.

Human walking has been observed since the presence
of man, in fact the methodical study of human gait dates
back to Aristotle and Leonardo da Vinci.2 Borelli, who was a
Journal of Clinical Engineering • Spring 2001


The width of the walkway varies with the number and type of equipment used. MEASUREMENT SYSTEMS AND TECHNIQUES Gait Analysis Walkway Clinical gait laboratories typically have defined walkways that are used for examinations. Visual Gait Analysis Direct visual gait analysis may be the simplest way to evaluate gait pattern.The images obtained by cameras may be used as a visible record by themselves. memory and analysis capability as applied to a relatively fast phenomenon. step width. has several serious limitations. especially cameras and one or more force plates. gait analysis has developed into a well established clinical and research method involving the capture and analysis of visual. Braune and Fischer used fluorescent strip-lights and multiple cameras to investigate the three dimensional movements of the body segments. and to eliminate starting and stopping effects. In contrast. From these early efforts. The human eye and brain cannot analyze very fast movements. In 1836. walking speed or pathological walking patterns of subjects. In 1878. used a truly scientific approach. For this purpose. so that he could study human limb movements.2 Visual gait analysis is transient so it does not leave a permanent record. it may be considered as the most complicated form of analysis since it involves only the human senses and brain. and then digitized to provide quantitative information. and EMG data. They were also the first to describe the gait cycle. When a patient or research subject walks 130 Journal of Clinical Engineering • Spring 2001 on the gait analysis walkway. and force and muscle information cannot be obtained through this analysis. Modern gait analysis labs use multiple camera systems so that clinicians can monitor the gait patterns from different views simultaneously. joint motion. The length required depends on several factors such as age. therefore.There are two types of measurement – direct and indirect. There are two different kinds of electrogoniometers . In 1895. He measured the center of gravity and described how constant forward movements of the supporting area provided by the feet maintain balance during walking. and observe high-speed events using slow-motion playback features. it is very important to know the subjects’ clinical history because the analysis may otherwise lead to misinterpretation. swing and stance duration. Muybridge used 24 cameras triggered quickly and successively to demonstrate how horses gallop.flexible strain gauge and potentiom- . He also studied the pressure under the foot and the path of the center of gravity. The need for a walkway is driven by the inconvenience of setting up the equipment. To be more effective. the Weber brothers in Germany accurately measured the timing of gait and of the pendulum-like swinging of the leg of a cadaver. many physicians and clinicians still include visual gait analysis as part of their clinical examination. cadence. Marey took multiple photographs of a subject who wore black clothes and had brightly illuminated stripes on the limbs on a single plate. This type of limb marking in various forms continues to be an important part of many modern motion recording systems. student of Galileo. Visual gait analysis. Indirect (non-contact) techniques use film or video cameras. Visual gait analysis is a useful technique to note gross abnormalities of a patient’s gait. Observers must be aware of normal gait patterns because pathology is recognized as deviations from normal function. The improved quality of moderate cost slow-motion has made this approach even more valuable. However. In the 1870s. a walkway must be long enough for the subject to take enough steps for analysis. external loading.A relatively simple adjunct to direct visual analysis is the use of video cameras and video recording/playing systems. Visual gait analysis is a highly subjective process and the quality of the analysis depends on the skill of the observer. and showed for the first time that there were times when all four feet were off the ground at once. two pioneers worked on kinematic measurement of human motion. the position and orientation of the limb segments and the joint angles are recorded. Electrogoniometers The electrogoniometer is used to continuously measure the angle of a joint. there is a tendency for the observer to neglect other subtle problems by focusing on the obvious movements.There is no standard for the size of the walkway and its minimum size is still in debate. Motion Analysis Systems (Kinematic Systems) Motion analysis systems are used in gait analysis to obtain the magnitude and timing of individual joint motion (See Table 2). It is then possible to record the observation permanently. and the foot support pattern can be measured. step length.Table 1: TYPICAL LAB COMPONENTS Walkway Motion Analysis Force Plate Electromyography Stride Parameters Energy Consumption* Data Processing Report Production * Energy consumption capability is less common.3 However. The direct techniques involve the use of electrogoniometers that are attached to the body. gait characteristics such as velocity. Despite these limitations. especially in the absence of access to a gait laboratory and its observational. stride length.

However. In spite of these disadvantages. it is more convenient to handle data from such systems than from cine photography because of the fast and automatic digitization process. it is possible to have digital data almost instantaneously. several commercially available automated motion analysis systems have been developed. Peak Performance (Englewood. When these active or passive markers are seen by more than one camera.3. the computer system and software can calculate the three-dimensional position of the markers. CA). the electrogoniometer has some drawbacks. CO) and Qualysis (Glastonbury. Film photography has been a popular method in gait analysis for about 100 years. which are usually light-emitting diodes (LEDs). trunk motion could be added to apparent hip motion.The subject typically wears black clothes and has reflective linear strips and markers placed on the lateral sides of the limb segments. a metal strip bends and an associated electrical signal. the motion of one of them may move the connecting arm of the next and cause “cross talk” problems. Room lights are dimmed and strobe lights illuminate the subject at some interval (usually 20 times/second) for a period of time while the film in the camera is exposed. is produced. which has equal intensity and opposite direction to the forces experienced on the foot of the weightbearing limb.The reflective markers are usually covered in Scotchlite™ (3M™. Video cameras are more useful than still cameras. and the spindles of the potentiometer are attached respectively to each limb segment. However. In addition. Glass covers allow for photography of foot contact from below. When the joint moves. A rotary potentiometer is a variable resistor. These data can then be fed to a computer directly for further display or analysis. The device must be placed and aligned on the joints of interest very carefully. visible video. MN).The force platform usually has a rigid top plate made of a large piece of metal or glass. the linear and angular velocities and accelerations can be calculated by mathematical differentiations. the relative angular movement between the two limb segments is perceived by the potentiometer and it provides a proportional electrical output to a recording system.3 In addition. CA). Since 1967. automated motion analysis systems should consist of at least four to six cameras. each camera has a light source such as infrared or visible light. Two basic techniques used are cine photography and multi-exposure still photography. the cost of materials is expensive and film processing takes time.They can handle faster events by recording between 25 to 500 frames per second. it is possible to have multi-axial measurements.The rotary potentiometer is more commonly used. Force Platforms (Kinetic Systems) The force platform. although without calibration. In order to assure complete coverage with no hidden markers. Motion Analysis Corporation (Santa Rosa. Other system uses active markers.As the joint moves. CT). The simplest method for kinematic measurement is a single video camera system.eter devices. The electrogoniometer is not suitable to measure hip joint movement since hip motion must be measured between the pelvis and thigh. These systems use either passive or active markers on the subject to identify the position and orientation of the body segments. Using videotape digitizers. Lake Forest. Once position data has been acquired. However. and automated video. which depends on the angle of the two limb segments. In addition. after the film has been processed. digitizing the data is still tedious and very time-consuming. For reasonably accurate kinematic measurement. also called strobe light photography. each end of the strain gauge is attached to the limb segments across a joint. With passive (reflective) marker system. a calibrated three-dimensional system using multiple cameras is used to make measurement from more than one viewpoint. Each of the four supporting corners has a set of three orthogonal force Journal of Clinical Engineering • Spring 2001 131 . It provides information about the ground reaction force.4 Therefore.The former technique takes a series of separate photographs very quickly. joint activity is not that of a simple hinge and therefore a fixed axis system provides only an approximation to the actual motion. However. Although simple in concept. the computer can differentiate markers easily and know which site is being recorded. Even for this application. video cameras are usually used to measure joint angles in the sagittal plane.Therefore. If more than one potentiometer is used on one joint. the angle between the walker’s path and camera is important since only at 90 degrees is the observation free of geometric camera lens distortion. Calibration of the device is important to avoid measurement errors. St. but the pelvis attachment strap is usually placed at the waist. These markers are activated in a selected order from a multiplexed power source. or with a help of a digitizer to have numerical values.2 Camera Systems There are three basic camera systems – film. despite these advantages the use of electrogoniometers is declining since camera-based kinematic systems have become so popular. Since the multi-axial electrogoniometer has more than one sensor linked in series.2 When the flexible strain gauge is used. they can be used in a relatively free ranging subject and provide continuous multi-step data. Paul. The potentiometer axis is located close to the joint axis. the user has to measure the joint angles manually. which is also called a force plate. which is the reflective material used for road signs. Using this kind of system. The latter technique uses a series of images with interrupted light that are superimposed on a single photograph. has now become standard equipment in many gait laboratories (See Table 3). The leading manufacturers of these camera systems include Oxford Metrics (Vicon. and special optoelectronic cameras. the electrogoniometer is still the most convenient and least expensive way to measure knee and ankle joint movements.4 A few gait laboratories still use cine photography because of the low cost of the equipment. it does not give accurate distance information.

Commercial force platforms have either six or eight channels for outputs. Today. In the past. However. From these data. When the pressure was applied. which was covered by an elastic mat. If the joint is rotating away from the direction in which the muscle is pulling. the power will be positive. however. It is not always easy to visualize the data although some systems are able to superimpose the force vector onto the video image for direct visual interpretation. For that. Six channel outputs are the three force vector magnitudes and three moments of forces in a coordinate system based on the center of the platform. when force platform data are combined with kinematic data. it is necessary to look at 132 Journal of Clinical Engineering • Spring 2001 what is termed the mechanical power. two force platforms are used. If it is moving in the direction of the muscle contraction. For accurate force plate data the subject must land with only one foot on the plate during each pass along the walkway. it is possible to perform calculations in which the limb is treated as a mechanical system. In walking. y. Using the force platform. it increases to 200-500 kPa and may go up to 1500 kPa with some sport activities. and they are usually placed offset in series. in effect to accelerate or decelerate the joint.With eight channels the output is composed of the four vertical signals from the forces sensors near the corners of the force platform. or its role in the pattern. has been used to generate a pedobarograph. the three components of force (vertical. which can cause excessive pressure that lead to ulceration. an edgelit glass plate. and z axes can be obtained. This is the joint moment multiplied by the angular velocity of the joint. it is possible to have a more detailed mechanical description of gait and the calculation of joint reaction forces. which are either piezoelectric or strain gauge transducers. The data obtained from force platforms give limited useful information by themselves. It does not explain which muscle is actually contracting. one for each foot. corresponding to concentric contraction of the effective muscle. In another method. moment about a joint and the mechanical power generated or absorbed at a joint of the lower limb can be computed. These sensors produce an electric output proportional to the force applied to the upper surface and the location of the contact point. When the relationship between the limb segments and the ground reaction vector is known.The foreaft component shows ‘braking’ and ‘propulsion’ during the stance phase. having the patient target a visible force plate location is not desirable as this may cause the patient to alter their gait in an abnormal way. while an examiner observed the contact of the foot or skin blanching from below to understand the applied pressures. the power will be negative. In another method.The lateral component of the force is typically relatively small. If the joint is not moving (an isometric contraction) the power will be zero. it compressed the mat onto the glass and made it have less reflectivity and become darker. (Watertown. One method had a subject stand on or walk across a glass plate. but not necessarily which muscles are responsible for that effect. printing ink was applied to a rubber mat having a pattern of ridges of different heights with a sheet of paper covering the mat. These calculations may be provided by software that is part of the force platform system.Table 2: MO TION AN AL YSIS MOTION ANAL ALYSIS Electrogoniometer Film Video • Visual • Direct to computer sensors.6 In normal gait the actual muscles corresponding to these activities are well known. low-technology methods were used. denoting an eccentric contraction. When the subject walked across it. The moment obtained indicates which muscle function (flexor or extensor) is active and how much moment (torque) is being exerted.2 The location of the center of pressure on the two-dimensional surface may be useful for identification of abnormal patterns of foot contact. the pressure distribution was shown on the paper. Typically the pressure beneath the foot in standing is 80-100 kPa. However in pathological gait the net effect of muscular activity is obtained. and the moments about the x. Therefore. two fore-aft components and two lateral components.This is very useful because it describes the function of a muscle contraction: whether the muscle is being used to do external work. The latter must be obtained from EMG data as described below. Foot pressure measurement systems may be floor mounted or of the insole type. MA) and Kistler (Amherst. lateral (side-to-side) and fore-aft). Pedobarography Measuring the pressure beneath the foot is useful with some conditions such as diabetic neuropathy and rheumatoid arthritis.2 Some diabetic neuropathy patients have pressures of 1000-3000 kPa beneath the foot as a result of abnormal gait patterns. Inc. moments and powers. Two major manufacturers of force platforms are American Mechanical Technology. or to absorb energy. the two coordinates of the center of pressure. it is possible to calculate the three components of force and moments and the two special coordinates of the force. which combines the vertical and fore-aft components of the ground reaction force. the force. When the data from both feet are required. electrical .5 The force may be considered as separate components and shown in a ‘butterfly diagram’. Most force platforms give a full three-dimensional description of the average ground reaction force vector beneath the foot. The vertical force typically shows two peaks separated by a valley with the first peak occurring during initial foot contact and the second peak reflecting push off. NY).

For overall magnitude determination.The acquired EMG may be printed or fed to a computer system through cable or telemetry system for data recording and quantification.These may be measured indirectly by using motion record systems.The timing of muscle action can be determined directly from the raw EMG record. with the negative portion of the signals transposed to the positive side to prevent canceling out of the positive and negative values. whether they are walking or not. Efficiency represents the percentage of physiological energy that is transformed into useful work.2 Moreover. fine-wire and needle electrodes. stance/swing periods and gait phases. it is not easy to directly measure the energy consumed during walking. Both pressure measurement systems are available from Novel (St.When the subjects walk across the array. Paul.3 EMG provides the timing of muscle activation and relative intensity of muscle function. When greater muscle actions occur. LA). Electromyography (EMG) is used to measure the electrical activity of a contracting muscle since muscle mechanical functions cannot be measured directly in intact subjects.01 second). foot flat. Modern gait laboratories now use automated instrumentations for stride analysis. the patient automatically and/or volitionally tries to maintain balance and make compensatory movements. gait cycle time and swing-phase duration can be calculated. Stride analysis provides some basic walking characteristics such as walking speed (velocity). 16 or 32 channels). rectified. The timing may be represented with the gait cycle interval.AZ). The rectified signal is integrated over a proper time interval (about 0. the signal is full-wave rectified. reliability can be a problem with long-term usage. In-shoe devices have a form of a thin film that also has an array of force sensors. Floor-mounted systems have an array of force sensors. The simplest means for stride measurement is with a stopwatch. people use metabolic energy all the time. The data may be normalized with some reference value and presented as a percentage of the reference.pressure sensors are used to get accurate and more comprehensive data. the vertical force distribution under the foot is measured. the EMG signals have higher amplitude and intensity. Electromyography It is often necessary to understand which muscles are contributing during the different phases of the gait cycle for a full understanding of normal and pathological gait. the energy consumption during walking is important for evaluation of the efficiency of gait.3 The sampling rate must be chosen carefully for reproduction of the original signal pattern and data storage. and cadence (step rate). Noraxon (Scottsdale. stride length can be calculated. with surface being the broadest and needle the most specific. and to handle the data more efficiently. According to energy conservation. or by direct methods involving foot contact systems. and typically has an energy cost. Therefore. CA) are a few of the manufacturers of electromyography systems. and integrated by a computer. If a person’s velocity and cadence are given. These types of electrodes measure varying degrees of detail with respect to specific muscle activity. Motion Lab Systems (Baton Rouge. Table 3: DIRECT FORCE MEASUREMENT Force Platform Pedobarography Stride Analysis Stride means the interval in the gait cycle between two consecutive steps with the same foot. Using footswitches. Three different kinds of electrodes can be used: surface. conductive rubber and piezoelectric materials. However. and Run Technologies (Laguna Hills.These elevated energy costs can be significant in terms of patient functionality. it is possible to monitor muscle actions at several locations. Walking velocity can be calculated with walking distance and timing. They are usually located under the heel and/or forefoot. For this analysis the length of the walkway must be long enough for the gait pattern to be free of end effects of decelerating.The EMG signal is typically digitally sampled. Data from both feet provide the single and double support times. Footswitch Systems The purpose of footswitches is to record the timing of gait and patterns of foot contact.The normalization process allows comparing activities among muscles. MN) and Tekscan (South Boston. The relative differences in the EMG from the same elect rode show the effort levels of acting muscles. The number of steps during the timed interval (usually one minute) is represented as cadence. but not necessarily the strength of contraction of individual muscles. In fact the increase in energy requirements can be dramatic for even small deviations from normalcy. Since current EMG measurement systems have a number of channels (8. the amount of energy generated after the complete metabolic degradation of food is equal to the energy Journal of Clinical Engineering • Spring 2001 133 .When abnormal gait occurs. MA). it is possible to measure the timing of initial contact.The quantified EMG may be presented in absolute values but it does not directly show how hard the muscle is working. Since footswitches have to endure very high stress. The mixture of normal and abnormal movements is presented as the resulting gait patterns.When more than two strides are measured. These systems use different kinds of force sensors such as resistive and capacitive strain gauges. heel rise and toe off. Energy Consumption Normal walking is energy efficient compared to that in a wide variety of abnormal conditions. turning and accelerating. stride length.

However even the gait lab medical director may require a pre-digested and formatted report depending on the volume and cost-effectiveness restraints of the laboratory. Applications of gait data Different kinds of data can be useful for different purposes in gait Force Platforms EMG systems Pedobarography 134 Journal of Clinical Engineering • Spring 2001 .de http://www.qualisys. Moreover. http://www. However. When both kinetic and kinematic data are available. Data Presentation As with all data intensive clinical modalities. joint moments and powers can be calculated (See Table 4).com http://amtiweb. Joint powers may identify powerful or weak muscles.3 Therefore. To identify relevant muscle activity. the measurement of oxygen consumption can be used as an indirect method to measure energy expenditure during an activity. the presentation of the results to the consulting expert and referring physician remains a challenging problem that has not yet seen widespread http://www. orthotic and surgical interventions.kistler. Joint moment data can be used to explain which parts of a joint tend to be involved and how much compression they have.emgsrus. Oxygen consumption analysis involves measurements of the subject’s exhaled breath. and there is rising concern about the impact of the measurement system on the phenomena being measured. and to plan and assess http://www.tekscan.2 Timing of walking can be used to recognize asymmetries of left and right steps or identify problems in balance and stability. APPENDIX I. with further consultation as required. the data do not directly describe which muscles are responsible for abnormalities. From these data. more modern systems can provide automated and locally standardized data presentation.Table 4 COMPUTED INFORMA TION INFORMATION Joint Force. the gait laboratory medical director) reviews the gait lab results and provides a summary and evaluation to the treating physician. They also can be used to observe improvement or worsening of a patient’s condition with particular intervention.runtech. The general gait parameters can be used to evaluate the degree of http://www.Abnormal movements of joints are quantified by the angle data of the joints. In most settings. the amount of oxygen consumed in a known time can be calculated. power Limb Kinematics* * other than those directly measured released by its oxidation.novel. Usefulness depends on the underlying value of the data with respect to its diagnostic clarity. these systems are complex and cumbersome.MotionAnalysis. While early systems required laborious data and manual or semi-manual http://www. this information is used clinically to understand a patient’s current condition and underlying pathology.g. its oxygen content and the amount of the carbon dioxide produced can be measured. The ratio of the carbon dioxide produced and the oxygen consumed can be used to determine the type of metabolism. prosthetic. Manufacturers of Gait Analysis Instrumentations Pr oduct Product Man uf actur er Manuf ufactur acturer Website URL Scotchlite™ Camera Systems 3M Oxford Metrics Limited MotionAnalysis Peak Performance Technologies Qualisys AMTI Kistler Noraxon Motion Lab Systems Run Technologies Novel Tekscan http://www. Unfortunately. a clinical expert (e. a thorough knowledge of normal patterns and values is essential to understanding deviations from normality. electromyography data may be used for further http://www.The total volume of the exhaled http://www. and the experience of the physician in seeing and interpreting the results.They also may be used to distinguish concentric and eccentric muscle contraction and passive tension in soft tissues. http://www.

S. F. Texas A&M University. For these reasons.G. REFERENCES [1] Davis. and Benedetti. To get more detailed information.E.pollo@baylordallas. (1996). M.The cost of modern gait analysis systems is decreasing and they are being more widely used due to their increasingly automated and user-friendly design. R... Butterworth Heinemann. (1988). REPRINTS Send all correspondence and reprint requests to: Gyusung Lee Biomedical Engineering Program Texas A&M University 233 Zachry Engineering Center College Station.. these systems give more accurate and valuable information than earlier. stride analysis. (1998). IEEE Engineering in Medicine and Biology Co-author Information Fabian E. Journal of Clinical Engineering • Spring 2001 135 . [5] Parekh R. (1992). Texas (214) 820-4086 fe. direct or recorded visual gait analysis. Burke. Gait Analysis. Biomedical Engineering Program.. kinetic/kinematic measurement. Master of Engineering Project Report. can be performed.CONCLUSIONS Gait analysis is used to measure and evaluate walking patterns. and an increasingly popular technical resource in hospitals and rehabilitation facilities. Gait Analysis: Normal and Pathological Function. and electromyography can be used.When a subject’s gait should be examined. Calculation of Joint Moments in the Human Leg During Normal Gait Using a Direct Contacting Kinematic System and a Force. (1994). M.TX 77843 (979) 845-5532 gslee@tamu. 3540. 17(3): 32-3. Catani. Clinical Gait Analysis in Biomechanics. systematic gait analysis has become more acceptable in clinical situations. As such it presents a new array of technical systems that become part of the hospital wide equipment management program. PhD Motion and Performance Laboratory Baylor University Medical Center Dallas. [3] Perry J... It involves different kinds of equipment and techniques. [4] Giannini. (1993). [2] Whittle. Slack Incorporated. Gait Analysis: Methodologies and ClinicalApplications. [6] Pollo. which is the simplest form of the analysis. Pollo. locally built and commercial devices.W. IEEE Engineering in Medicine and Biology Magazine.. III. B. Moreover. VA: IOS Press. Clinical Gait Analysis. These data can explain the pattern of the subject’s gait more systematically.