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but triggering on the QRS complex should result in reliable
operation.
A number of modifications could be made to the unit to
enhance its capability and performance. The instrument in its
present form makes two rate measurements for every four
QRS complexes. This could be changed so that a measure-
ment is made for each QRS complex with a minimal change
in control circuitry. Various pacemaker clinics may de-
modulate the transmitted signal differently, consequently
requiring other pacemaker pulse triggering circuitry. Other
methods of triggering, such as a frequency selective circuit or
slope differentiation, could be employed. Also, an automatic
gain control circuit could be incorporated in the analog
processor to eliminate the manual gain control and increase
its capability to trigger on very low amplitude signals. With
recent advances in state-of-the-art MSI low power digital logic
(CMOS or LPTTL), the circuit could be reconfigured to fit
in a package the size of a pack of cigarettes. This would
allow portable operation using self-contained rechargeable
NiCad batteries.
SUMMARY
The digital heart rate meter described is sufficiently accurate
to be used in most clinical situations with the advantages of
low component cost and ease of operation. The device is
presently in use in a pacemaker clinic with a history of over
75 reliable operations. The instrument has the following
features: (1) instantaneous digital heart rate indication; (2)
choice of ventricular or pacemaker triggering; (3) system test
capability; (4) computer interface capability. All of these
features combine to make an excellent general purpose instru-
ment with a variety of applications.
Complete schematics and parts list are available on request
from the authors.
ACKNOWLEDGMENT
The authors wish to thank Dr. Harold Knight and Mr.
Walter Wohlfert, Department of Cardiovascular Surgery, Saint
Francis Hospital, Hartford, Connecticut, for their assistance in
the clinical trials of this instrument.
A Simple Electrogoniometric System and Its Testing
AMADEJ TRNKOCZY AND TADEJ BAJD
Abstract-A simple goniometric system intended for quantitative eval-
uation of a patients' gait is described. The hip, knee and ankde angles
of both legs in the sagittal plane and the contacts between ground and
three parts of the sole were measured. By using a special knob to adjust
and fix the knee potentiometer axis position, a small number of selec-
tively chosen attachments and very light construction, the gait was dis-
turbed to the minimum extent. The system's accuracy was tested by
comparing the directly measured step length and the calculated one.
The accuracy achieved was better than 5%.
Manuscript received June 4, 1974. This work was supported by the
Slovene Research Community, the Boris Kidric Foundation, and the
Department of Health, Education, and Welfare, Social and Rehabilita-
tion Service, Washington, D. C., under Grant 19-P-58415-F-O1.
The authors are with the Institute "J. Stefan," the University of
Ljubljana, Ljubljana, Yugoslavia.
257
INTRODUCTION
Methods for the evaluation of human gait are still insuffi-
ciently objective. Estimating the rehabilitation degree of pa-
tients using orthotic or prosthetic devices is left to medical
specialists, and the conclusions drawn are understandably not
absolutely objective. Different authors have designed and de-
veloped measuring equipment which would provide the data
necessary for the quantitative evaluation of a gait. A variety
of methods -is known for measuring goniometric functions as
essential parameters of gait pattern.
The most simple is the analog measurement of joint angles
by potentiometers [1]-[41, [7], [9]. Advantages of this
method are simplicity, low cost and suitability for on-line
computer analysis. On the other hand, the equipment be-
comes quite heavy and obstructs walking if it is not carefully
designed. Another method requires filming marked sections of
a leg by movie camera or by stroboscopic photography [5],
[8 ]. The method is inadequate for routine application since it
requires longer times for processing and is absolutely unsuit-
able for on-line computer evaluation. Far more attractive is
the application of television cameras, but this method requires
rather expensive instrumentation. At one time only five con-
secutive steps of a single leg can be evaluated [6]. Therefore
adequate statistical analysis of a greater number of steps is dif-
ficult. It also does not allow measurement of the symmetry of
left and right leg movement.
The system for gait evaluation described in this paper is
based on the first-mentioned technique. The disadvantages of
this method were kept to the minimum.
DESCRIPTION OF MECHANICAL PARTS
The most crucial feature of the mechanical goniometric sys-
tem is its simple, sufficiently firm, repeatable and fast attach-
ment to the experimental subject. Attachments have to be
made by contacts at bony prominences rather than fleshy
areas. The number of attachments must be as low as possible
since each of them disturbs the subject.
Three attachments were chosen, namely about the belt, un-
der the knee (just above the fibula) and on the shoe heel
[Fig. 11. The customary separate attachments of goniometric
potentiometer legs to the limb were discarded: instead a spe-
cial external lightweight framework was developed, which
halved the necessary number of attachments. The attachment
to the femur was omitted, since of all major skeleton segments
of the lower limb, the femur is by far the most difficult to
attach a measuring device to [3]. The external framework
eliminates all errors which would arise from the movements
between two adjoining potentiometer legs (e.g., the distal leg
of the hip goniometer and the proximal leg of the knee
goniometer).
It was supposed that for gait evaluation it is sufficient to
measure joint angles in the sagittal plane. Displacements in
other planes as well as displacements of the pelvis were ne-
glected. Free displacements in the coronal plane (transverse
displacements) of bars interconnecting the potentiometers
(steel 0 2.5 mm) were facilitated by a ball joint on one end
[Fig. 1(3)], and a special hole in the potentiometer axis at the
other end of the bar [Fig. 1(2)]. The hole is oblong and runs
along the axis. It allows free movement of the bars in the co-
ronal plane and slipping in the distal-proximal direction. This
prevents bending stresses on the bars as well as tensile or com-
pression stresses caused by small changes in distances between
goniometer axes. These changes are caused by the fact that
centers of rotation of joints during the gait are not fixed with
regard to segments of the extremities. They follow a certain
concave curve [1]. This phenomenon is most obvious at the
knee joint. The curved line cannot be traced easily with
258
(a)
(b)
(c)
Fig. 1. The attachment of (a) ankle, (b) knee and (c) hip goniometer.
(1) The knob used for fixing the potentiometer axis in the approxi-
mate knee joint axis. (2) Oblong hole in potentiometer axis, allowing
free movement of the joining bar in the coronal plane and distal-
proximal direction. (3) Ball joint between knee goniometer and the
bar leading to the ankle.
simple technical approaches. A small error was introduced
intentionally by placing the potentiometer axis into the ap-
proximate center of the form encircled by the curve. The
movement of potentiometer axis away from preselected posi-
tion was restricted by a knob having a conical deepening in
which the goniometer axis was put into [Fig. 1(1)], and which
had been attached by surgical adhesive strap. The attachments
of the hip and ankle goniometers with the aid of a belt and a
metal heel ring are shown in Fig. 1. The adjustments required
for different subjects were attained by exchanging intercon-
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, MAY 1975
necting bars of different length and by using heel rings of
varying size.
Besides the goniometers tape-switches glued between two
thin leather pieces were used as foot-switches. They were
fastened into the shoe sole by plastic adhesive tape. Switches
on the heels and toes were made from three separate switches
connected in parallel and placed in a semicircular arrangement
while the switch in the middle of the sole was as wide as the
shoe. In this way a satisfactorily reliable switching was en-
sured even with patients (hemiplegics) who usually have in-
verted feet. Smaller switches, fixed centrally were far less
reliable. All of the equipment mounted on the subject
weighed less than 750 g.
Data collected were transmitted to the recording system via
a lightweight, 60 m long flexible 10-lead cable. The long walk-
way permits statistical treatment of gait parameters. The
other possibility for transmission, telemetry, was abandoned
because of high cost, low reliability and the usual presence of
nonlinearity problems. The person conducting the experiment
accompanied the subject along the walkway (his presence was
anyway necessary for safety reasons when patients were in-
volved) carrying the cable and so removed its friction with the
ground.
DESCRIPTION OF THE ELECTRICAL PARTS
The potentiometers used were lightweight (14 g), miniature
(o 18 mm), precise (nonlinearity less than 1% and wire-wound
(1070 w/3500, finite resolution caused by individual wires
< 0,30) with ball bearings and no mechanical stops to prevent
mechanical damage due to inadvertently large motions. The
electronics consists of six resistor bridges. The bridge output
voltages are amplified by integrated circuit amplifiers. The
output voltages are adjustable to all recorders and AID con-
verters (sensitivity from 10 V/1000 to 500 mV/1000). It is
possible to change signal polarity and to generate a calibration
voltage equivalent to 100. The magnitude of zero adjustment
and angle changes can be observed on an instrument. Switches
on the heel are electrically weighted so that each combination
of closed switches generates adequate output voltage. The
swing phase and different sections of stance phase can produce
a maximum of 8 voltage levels, although only 6 are physically
feasible.
ACCURACY TEST OF THE SYSTEM
The extent to which measured angles correspond to actual
joint angles was checked in the following manner. In each
heel-on time the angles were read out for all six joints. From
the measured distances between potentiometer axes, the foot
size and, from read-out angles, the step length were calculated
using the trigonometric formula
d = 11 sin as + r, sin 31 + 12 sin (a1 +C2) + r2 sin (13k - 132)
+ 13 sin (a1 + 2 - 3) + r3 sin (11 -12 + 33)
+d[l cos(1
- -
2 +03)]+d2 [I cos(oil +2 -a3)]-
-
The definitions of lengths and angles are given in Fig. 2.
Computed values were then compared to actual ones defined
by the distance between two subsequent ink stamp pad marks
on paper bands which covered the walkway where the patient
walked.
The experiment was conducted for an average distance of 70
steps with five subjects of different age and height. Five mea-
surements on the same subject were performed to find out
how precisely joint axes can be determined by simply observ-
ing the leg anatomy. Through step lengths calculation it was
intended to reveal how accurately the angles can be measured
depending on the use of a more or less subjective method for
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Fig. 2. Position of both legs at the moment when the values of angles,
needed for the calculation of step length, are read out.
determining the joint axes. The whole system was five times
mounted and dismounted and at each search for joint axes
there was no information available on previous mountings, due
to long time intervals between the experiments which were
performed by three different experimenters.
The mean systematic error and mean absolute error were for
all five mountings and for all five subjects measured smaller
than 1.5% and 4.8%, respectively. The conclusion can be
drawn that simple visual determination of potentiometer posi-
tion is sufficiently accurate. Statistical errors are most likely
to come from inexact readings of angles from graphical rec-
ords, which were only a few centimeters wide. The resolution
was therefore limited. When outputs are connected to a com-
puter via an AID converter, it is expected that these errors are
reduced substantially.
CONCLUSION
The described goniometric system of simple and expedient
design gives sufficiently accurate goniometrical and basograph-
ical data suitable for on-line computer processing. Because of
its lightnes and adequate attachments it only moderately inter-
feres with the subject's gait.
The accuracy attained for angles (since hip and knee angles
are rather small and sin 4 t is valid) is better than 5%. The
system can be connected to a processor computer for on-line
statistical analysis of stride and step durations, gait speed, step
length, symmetry and correlation study of goniograms, etc.
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[11 P. V. Karpovich, E. L. Herden, and M. M. Asa, "Electrogonio-
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A Simple Computer-Television Interface System
for Gait Analysis
IN-SHENG CHENG, S. H. KOOZEKANANI, MEMBER, IEEE,
AND M. T. FATEHI, STUDENT MEMBER, IEEE
Abstract-A new method for analysis and recording of gait paramn-
eters is reported. This method consists of a television camera inter-
faced with a PDP-11/10 minicomputer. The TV camera picks up
anatomical points of interest such as knee joint, ankle joint, etc., to
which small lights are attached and the computer calculates their co-
ordinates and joint angles as a function of time.
Manuscript received June 14, 1974. This work was supported by the
National Science Foundation under Grant GK-25292.
The authors are with the Department of Electrical Engineering, the
Ohio State University, Columbus, Ohio 43210.