Comparison of a Clinical Gait Analysis Method Using

Videography and Temporal-Distance Measures with

16-mm Cinematography
Wayne A Stuberg, Vicki L Colerick, Daniel J Blanke and
Wendy Bruce
PHYS THER. 1988; 68:1221-1225.

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Comparison of a Clinical Gait Analysis Method

Using Videography and Temporal-Distance
Measures with 16-mm Cinematography
WAYNE A. STUBERG,
VICKI L. COLERICK,
DANIEL J. BLANKE,
and WENDY BRUCE
The purpose of this study was to compare a clinical gait analysis method using
videography and temporal-distance measures with 16-mm cinematography in a
gait analysis laboratory. Ten children with a diagnosis of cerebral palsy ( age =
8.8 2.7 years) and 9 healthy children ( age = 8.9 2.4 years) participated in
the study. Stride length, walking velocity, and goniometric measurements of the
hip, knee, and ankle were recorded using the two gait analysis methods. A
multivariate analysis of variance was used to determine significant differences
between the data collected using the two methods. Pearson product-moment
correlation coefficients were determined to examine the relationship between the
measurements recorded by the two methods. The consistency of performance
of the subjects during walking was examined by intraclass correlation coefficients. No significant differences were found between the methods for the
variables studied. Pearson product-moment correlation coefficients ranged from
.79 to .95, and intraclass coefficients ranged from .89 to .97. The clinical gait
analysis method was found to be a valid tool in comparison with 16-mm cinematography for the variables that were studied.
Key words: Cerebral palsy, gait; Gait; Kinesiology/biomechanics, gait analysis;
Tests and measurements, general.

For the clinician, gait analysis re

mains primarily a subjective process of
visual examination. The obvious limi
tation in the use of this observational
method is the lack of objective infor
mation to diagnose gait disorders, pro
vide accurate follow-up, or examine the
efficacy of treatment. Goodkin and

W. Stuberg, MS, is Assistant Professor and Direc

tor of Physical Therapy, C. Louis Meyer Children's
Rehabilitation Institute, University of Nebraska
Medical Center, 444 S 44th St, Omaha, NE 68131
(USA).
V. Colerick, BS, is Staff Physical Therapist,
Shriners Hospitals for Crippled Children, 2211 N
Oak Park Ave, Chicago, IL 60635. She was a phys
ical therapy student, University of Nebraska Medi
cal Center, when this study was conducted.
D. Blanke, PhD, is Associate Professor, School of
Health, Physical Education, and Recreation, Uni
versity of Nebraska at Omaha, Omaha, NE 68182.
W. Bruce, BS, is Staff Physical Therapist, Chil
dren's Memorial Hospital, 8301 Dodge St, Omaha,
NE 68114.
This study was presented at the Sixty-Second
Annual Conference of the American Physical Ther
apy Association, Chicago, IL, June 812, 1986.
This article was submitted May 26, 1987; was
with the authors for revision 13 weeks; and was
accepted December 28, 1987. Potential Conflict of
Interest: 4.

Diller reported interrater agreement

among three physical therapists ranging
from 60% to 93% in identifying com
mon gait deviations in patients with
cerebrovascular accidents.1 Additional
limitations of clinical observation have
also been reported in studies using visual
gait analysis recorded by videography
in children with meningomyelocele2
and amputees using lower extremity
prostheses.3
The limitations of qualitative gait
analysis can easily be overcome by the
use of instrumentation. Sophisticated
methods using force plates, electrogoniometry, electromyography, or cine
matography have been established.4,5
These methods, however, do not meet
the needs of the clinician who has lim
ited access to specialized equipment or
time for data collection and analysis of
the numerous gait variables.
Temporal-distance (TD) measure
ment methods such as footprint analysis
from a walking track are clinically fea
sible and have been documented widely
in the literature.6-13 Step and stride
length, walking velocity, dynamic base

of support, tracking angle, and cadence

can be recorded quickly and objectively.
The test-retest reliability of TD meas
ures has been reported for healthy
women (r = .69-.97)6 and for subjects
with multiple sclerosis and hemiparesis
(r = .47-.97),11 hip disorders (r =
.96-.99),14 and mild neurological defi
cits(r = .89-.99).15
Videography equipment commonly is
available in the clinic and, when com
bined with TD measures, provides the
clinician with additional objective infor
mation on posture and joint position
during the gait cycle. The goniometric
measures are particularly important in
delineating the significance of TD meas
urement changes as a function of
changes in postural alignment.
The purpose of this study was to ex
amine the validity of a clinical gait
analysis method using videography and
TD measures versus standard 16-mm
cinematographic gait analysis. We hy
pothesized that no significant difference
would be found between the two meth
ods of gait analysis for the variables
studied.

Volume 68 / Number 8, August 1988

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1221

METHOD
Subjects
Nineteen children, aged 7 to 12 years,
participated in the project. Ten children
were diagnosed as having cerebral palsy
(5 with spastic diplegia, 3 with spastic
quadriplegia, and 2 with spastic left
hemiplegia), and the other 9 children
had no history of neuromuscular disor
ders. The children in the Cerebral Palsy
Group ( age = 8.8 2.7 years) were
receiving therapy services at C. Louis
Meyer Children's Rehabilitation Insti
tute, and the children in the Unimpaired
Group ( age = 8.9 2.4 years) were
siblings or volunteers. All children were
independently ambulatory for distances
greater than 50 m without orthoses or
assistive devices. Informed consent fol
lowing university guidelines for research
involving human subjects was obtained
before data collection.
Instrumentation
The clinical gait analysis method in
volved the use of a tripod-mounted Pan
asonic camera* with Sony Model VO6500 3/4 Umatic videotape recorder
positioned perpendicular to the center
of a 1- 10-m paper walking tract (Fig
ure). The distance from the walking
tract to the camera was 8 m. Ink-soaked
moleskin markers on the subjects' feet
and a stopwatch were used to record the
TD measurements.
Simultaneous high-speed cinematog
raphy was used to record the subject's
gait. A LoCam camera with a 25-mm
Cosmicar lens was juxtaposed to the
video camera. The LoCam camera was
set at 50 frames a second and verified
using an internal timing light generator.
Both cameras were positioned with the
lenses 0.73 m from the floor. Kodak
7277 tungsten black and white film
(ASA 320) was used in the LoCam cam
era. A 1-m reference scale was included
in the field of view of both cameras.
Two Pallite VIII lights were used in
addition to ambient lighting.
The videography data were analyzed
using a Sony Model CVM-1900 video
tape monitor and a 1-degree increment
* Model WV-3900, Panasonic Co, 50 Meadowlands Pkwy, Secaucus, NJ 07094.
Sony Corp of America, 1 Sony Dr, Park Ridge,
NJ 07656.
Redlake Corp, 1711 Dell Ave, Campbell, CA
95008.
Eastman Kodak Co, 343 State St, Rochester,
NY 14650.
|| Photographic Analysis Ltd, 210 Don Park Rd,
Unit 12, Markham, Ontario, Canada L3R 2V2.

Figure. Walkway plan of Gait Analysis Laboratory and clinical gait analysis method.

plastic goniometer.# Data from the pe

riphery of the screen were not included
in the measurements to decrease error
attributable to angle parallax. The go
niometer was checked against known
angles to ensure validity. The 16-mm
processed film was displayed, and the
desired measurements were made di
rectly from the projected image using a
PCD digitizer.**
Procedure
All testing was performed at the Gait
Analysis Laboratory at the University of
Nebraska at Omaha. The children were
dressed in swimsuits or leotards. A 1.9cm white dot with a 0.6-cm blue center
was placed on the following anatomical
landmarks of the child's left side: lateral
border of the acromion process, greater
trochanter, lateral knee joint line, lateral
malleolus, and lateral head and base of
the fifth metatarsal. Ink-soaked 2-cm
moleskin markers were placed on the

# DePuy-Nerr Co, PO Box 988, Warsaw, IN

46580.
** Model ZAElc, PCD Ltd, Invincible Rd, Farnborough, Hampshire, GU14-7QU, England.

soles of the subject's feet at the calcaneus

and head of the second metatarsal.
The subject then walked at a selfselected velocity along the 10-m walk
way. The measurements were recorded
from the center 4 m of the walkway to
ensure a constant walking velocity. A
stopwatch was used to time four consec
utive stride lengths of the left foot, which
were marked on the paper and noted on
the film and videotape for analysis. Each
subject performed a practice trial before
data collection to become familiarized
with the walkway and procedure. A sec
ond trial was requested of children who
did not perform the procedure in a con
tinuous or complete manner.
Measurements
We used a modified procedure that
was described by Sutherland and Hagy16
and validated in 1980 by Sutherland et
al17 to obtain the measurements from
the processed film. The modified pro
cedure involved the use of only one
camera recording movement in the sag
ittal plane and use of a special protractor
on the projector screen to record goniometric angles. The variables meas
ured were walking velocity; stride
PHYSICAL THERAPY

1222
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RESEARCH
length; and hip, knee, and ankle angle
at mid-stance. Mid-stance was defined
as the point in the gait cycle when a line
bisecting the trochanter and lateral mal
leolar marker was perpendicular to the
floor. Stride length was measured as the
distance between two consecutive left
heel-strikes. Actual stride length was cal
culated by multiplying the scale factor
obtained from the 1-m reference scale
in the camera view by the measured film
stride length. Average walking velocity
was recorded as the total distance trav
eled during three consecutive strides di
vided by the amount of time elapsed
during the movements. The amount of
time elapsed was calculated by counting
the number of frames for the desired
movement and dividing the number of
frames by the film speed of the camera.
Walking velocity was then calculated by
dividing the distance by the amount of
time elapsed. Three strides were used for
the data analysis because the fourth
stride was commonly on the edge of the
video monitor. Four strides could have
been measured for all children using the
film data. Goniometric angles were
measured directly from the viewing
screen using the digitizer's protractor.
The axis of the protractor was posi
tioned over the corresponding joint
marker (eg, at the knee), and the pro
tractor arms were then positioned to
bisect the adjacent joint markers (eg, at
the hip and ankle).
Stride lengths for the clinical gait
analysis method were measured directly
from the walkway footprints. Walking
velocity was calculated by dividing the
distance between the first and fourth
heel prints by the amount of time
elapsed on the stopwatch.
Goniometric measurements of the
hip, knee, and ankle were measured
from the videotape monitor screen using
a 1-degree increment goniometer. Stop
action of the videotape and a plumb line
on the screen were used to identify the
mid-stance phase of the gait cycle. The
measurements were then recorded for
the three consecutive gait cycles corre
sponding to the measurements obtained
from the film data. All videotape and
film measurements were recorded by
one author (W.A.S.), and the walkway
measurements were recorded by another
author (V.L.C.).
Data Analysis
A multivariate analysis of variance
(ANOVA) was used to compare average
left stride length and goniometric meas

urements at the hip, knee, and ankle as

recorded by 16-mm cinematography
versus videography and the TD meas
urements. A paired t test was used to
compare the determination of walking
velocity by the two methods. The t test
was used for walking velocity because
only one measurement per child was
obtained, as opposed to the three re
peated measurements for the other vari
ables. Pearson product-moment corre
lation coefficients were also calculated
to determine the relationship between
the two methods of gait analysis. The
two groups of children were combined
for the data analysis, and the correla
tions were calculated using the mean
value of the three strides for each vari
able except walking velocity. Intraclass
correlation coefficients (ICC[3,1]) were
calculated to determine the consistency
of performance between the three strides
used for the data analysis. All compari
sons were evaluated at the .05 level of
significance.
RESULTS
Table 1 lists the means and standard
deviations comparing the two methods
for the variables measured. The children
in the Unimpaired Group demonstrated
a faster walking velocity, a greater stride
length, and a more erect posture as com
pared with the children in the Cerebral
Palsy Group. The more erect posture of
the children in the Unimpaired Group
at mid-stance is evidenced by the lesser
angles at the hip and knee and greater
ankle angle in comparison with the chil

dren in the Cerebral Palsy Group. Stride

length and walking velocity were con
sistently smaller and goniometric meas
urements greater for the clinical method
using videography and the TD measure
ments as opposed to cinematography.
The results of the univariate and mul
tivariate ANOVAs are shown in Table
2. No significant difference between the
two methods was found for the individ
ual variables as shown in the univariate
ANOVA. In comparing the vector of
variables for the two methods, Wilk's
Lambda (F = 0.40; df= 4,140; p = .81)
was not significant. Mean walking ve
locity for the Unimpaired and Cerebral
Palsy Groups was 0.98 m/sec (s = .21)
and 1.04 m/sec (s = .24), respectively.
No significant difference (t17 = -0.68,
p > .05) was demonstrated between the
mean walking velocity of the two
groups.
Pearson correlation coefficients
ranged from .79 for stride length to .95
for knee angle (Tab. 3). Intraclass cor
relation coefficients ranged from .84 to
.97 for the Unimpaired Group and from
.84 to .99 for the Cerebral Palsy Group
(Tab. 4). The ICCs were significant
across all measurements for both
groups.
DISCUSSION
Clinical reports using videography
have primarily focused on its use as a
tool to collect descriptive information
rather than measuring variables directly
from the video monitor.3,18 The results
of our study support the use of videog-

TABLE 1
Comparison of Gait Variables Using Videography and Temporal-Disease Measures
Versus 16-mm Cinematography

Variable

Cerebral Palsy
Group
(n = 10)

Unimpaired
Group
(n = 9)
s

s
Hip angle ()
Video
Film
Knee angle ()
Video
Film
Ankle angle ()
Video
Film
Walking speed (m/sec)
Paper
Film
Stride length (m)
Paper
Film

12.84
11.12

11.87
10.22

5.63
3.41

7.67
4.87

15.88
15.08

17.33
15.58

8.89
6.47

5.60
5.00

7.84
7.16

9.66
11.54

4.79
2.82

3.01
3.38

0.77
0.78

.18
.20

0.98
1.04

.21
.18

0.70
0.74

.26
.26

0.97
1.01

.25
.24

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1223

TABLE 2
Univariate and Multivariate Analyses of Variance Comparing Variables Recorded by the
Two Gait Analysis Methods
Univariate Analysis of Dependent Variables
Source

df

SS

MS

Hip angle
Error
Knee angle
Error
Ankle angle
Error
Stride length
Error

1
107
1
107
1
107
1
107

8.63
8865.81
17.02
18765.54
30.32
7190.91
0.03
5.10

8.63
82.86
17.02
175.38
30.32
67.20
0.03
0.05

0.10

.75

0.10

.76

0.45

.50

0.48

.49

Multivariate Analysis of Dependent Variables

Wilk's Lambda

df

0.40

4,104

.81

TABLE 3
Pearson Product-Moment Correlation
Coefficients of Variables Comparing
the Two Gait Analysis Methods

Variable

ra

Hip angle ()
Knee angle ()
Ankle angle ()
Walking speed (m/sec)
Stride length (m)

.84
.95
.89
.86
.79

p < .05.

raphy and TD measures to collect ob

jective gait measurements as an alter
native to 16-mm cinematography in a
gait analysis laboratory. The hypothesis
that no significant difference between
the two methods would be obtained for
the variables tested was supported.
The consistency of performance be
tween the three strides that were meas
ured was stable as evidenced by the
strong ICCs for both the Cerebral Palsy
and Unimpaired Groups. No trend to
ward one method demonstrating greater
consistency for the measures was noted.
The lesser walking velocity for the TD
measures reflects a consistent over
estimate in recording the time lapse be

tween the first and fourth left heel-strike

using a stopwatch. No significant error
in the measurement of walking velocity
from the film data would be expected
because the resolution of the digitizer in
the frame-by-frame analysis is 0.02 sec
onds at a film speed of 50 Hz. The lesser
measurements for stride length for the
film data reflected an overestimate of
the distance using the digitizer as com
pared with the actual measurements ob
tained with a meter stick.
Limitations of the videography equip
ment to record gait measurements
should be considered by the clinician
setting up a project. The film speed for
most videography equipment is 30 Hz,
which limits the resolution of the image
on the monitor with high-velocity
movements. For example, a frame-byframe analysis of the swing phase of gait
can be conducted with cinematography
using a film speed of 50 Hz, but the
videography image on the monitor will
be blurred and unmeasurable. This lim
itation can be averted by measuring
variables during the stance phase of gait.
The consistently larger values of the
goniometric angles for the videography
data were probably due to angle parallax

TABLE 4
Intraclass Correlation Coefficientsa Comparing Three Repeated Measurements for
Each Variable
Unimpaired Group
(n = 9)

Cerebral Palsy Group

(n = 10)

Variable

Hip angle
Knee angle
Ankle angle
Stride length
a

Film

Video and
Walkway

Film

Video and
Walkway

.97
.91
.84
.95

.94
.94
.88
.94

.94
.99
.94
.98

.84
.95
.97
.97

All correlations are significant at p < .05.

introduced by measuring the images

from the video monitor screen. The de
gree of parallax can be controlled, as in
this study, by measuring only images in
the center of the monitor screen. A
video image unit would control for the
parallax for research applications; how
ever, the unit is prohibitively expensive
and not available in the routine clinical
setting.
Clinical Implications
Because 16-mm cinematography is
expensive and has limited availability in
the average clinic, the use of videogra
phy with TD measures as a substitute
would allow the clinician to obtain val
uable information for research or assess
ment of treatment efficacy. The knowl
edge of selected goniometric measures
during the gait progression provides the
clinician with insight pertaining to the
mechanism behind changes in the TD
measurements. For example, an in
crease in stride length and walking ve
locity at the expense of an increase in
the crouched walking position of a child
with spastic diplegia may not be a de
sired treatment outcome. Additional
TD measures can also be considered for
use dependent on the clinician's need.
Step length, dynamic base of support,
tracking angle, and cadence can be doc
umented easily.6,7,19
CONCLUSIONS
Walking velocity, stride length, and
goniometric angles at the hip, knee, and
ankle as measured by a clinical gait
analysis method using videography and
TD measures were found to be consist
ent with measurements recorded in a
gait analysis laboratory using 16-mm
cinematography. The clinical gait analy
sis method was designed for use by cli
nicians to analyze gait deviations or to
study the outcome of therapeutic input
affecting gait, orthotic use, or operative
management procedures.
Limitations in the use of videography
should be considered in collecting
clinical research data. Adherence to a
standardized protocol for collection of
videography data is necessary to avoid
significant measurement error by the
clinician. The methodology used in this
study was found to be consistent with
the rigorous criteria used in a formal
gait analysis laboratory.
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RESEARCH

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Volume 68 / Number 8, August 1988

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1225

Comparison of a Clinical Gait Analysis Method Using

Videography and Temporal-Distance Measures with
16-mm Cinematography
Wayne A Stuberg, Vicki L Colerick, Daniel J Blanke and
Wendy Bruce
PHYS THER. 1988; 68:1221-1225.

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