{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T10:06:59Z","timestamp":1771063619410,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Brain Research Foundation Verona ONLUS"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Axial postural abnormalities (aPA) are common features of Parkinson\u2019s disease (PD) and manifest in over 20% of patients during the course of the disease. aPA form a spectrum of functional trunk misalignment, ranging from a typical Parkinsonian stooped posture to progressively greater degrees of spine deviation. Current research has not yet led to a sufficient understanding of pathophysiology and management of aPA in PD, partially due to lack of agreement on validated, user-friendly, automatic tools for measuring and analysing the differences in the degree of aPA, according to patients\u2019 therapeutic conditions and tasks. In this context, human pose estimation (HPE) software based on deep learning could be a valid support as it automatically extrapolates spatial coordinates of the human skeleton keypoints from images or videos. Nevertheless, standard HPE platforms have two limitations that prevent their adoption in such a clinical practice. First, standard HPE keypoints are inconsistent with the keypoints needed to assess aPA (degrees and fulcrum). Second, aPA assessment either requires advanced RGB-D sensors or, when based on the processing of RGB images, they are most likely sensitive to the adopted camera and to the scene (e.g., sensor\u2013subject distance, lighting, background\u2013subject clothing contrast). This article presents a software that augments the human skeleton extrapolated by state-of-the-art HPE software from RGB pictures with exact bone points for posture evaluation through computer vision post-processing primitives. This article shows the software robustness and accuracy on the processing of 76 RGB images with different resolutions and sensor\u2013subject distances from 55 PD patients with different degrees of anterior and lateral trunk flexion.<\/jats:p>","DOI":"10.3390\/s23063193","type":"journal-article","created":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T02:59:26Z","timestamp":1679021966000},"page":"3193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Camera- and Viewpoint-Agnostic Evaluation of Axial Postural Abnormalities in People with Parkinson\u2019s Disease through Augmented Human Pose Estimation"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3193-6798","authenticated-orcid":false,"given":"Stefano","family":"Aldegheri","sequence":"first","affiliation":[{"name":"Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8579-3772","authenticated-orcid":false,"given":"Carlo Alberto","family":"Artusi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience \u201cRita Levi Montalcini\u201d, University of Turin, 10124 Turin, Italy"},{"name":"Neurology 2 Unit, Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Turin, Italy"}]},{"given":"Serena","family":"Camozzi","sequence":"additional","affiliation":[{"name":"Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3644-352X","authenticated-orcid":false,"given":"Roberto","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6095-1930","authenticated-orcid":false,"given":"Christian","family":"Geroin","sequence":"additional","affiliation":[{"name":"Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4842-529X","authenticated-orcid":false,"given":"Gabriele","family":"Imbalzano","sequence":"additional","affiliation":[{"name":"Department of Neuroscience \u201cRita Levi Montalcini\u201d, University of Turin, 10124 Turin, Italy"},{"name":"Neurology 2 Unit, Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Turin, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9098-387X","authenticated-orcid":false,"given":"Leonardo","family":"Lopiano","sequence":"additional","affiliation":[{"name":"Department of Neuroscience \u201cRita Levi Montalcini\u201d, University of Turin, 10124 Turin, Italy"},{"name":"Neurology 2 Unit, Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Turin, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2370-7063","authenticated-orcid":false,"given":"Michele","family":"Tinazzi","sequence":"additional","affiliation":[{"name":"Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3256-5885","authenticated-orcid":false,"given":"Nicola","family":"Bombieri","sequence":"additional","affiliation":[{"name":"Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1002\/mds.25684","article-title":"Objective Biomarkers of Balance and Gait for Parkinson\u2019s Disease Using Body-worn Sensors","volume":"28","author":"Horak","year":"2013","journal-title":"Mov. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1002\/mds.22561","article-title":"Clinical and physiological assessments for elucidating falls risk in Parkinson\u2019s disease","volume":"24","author":"Latt","year":"2009","journal-title":"Mov. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1056\/NEJMcp043908","article-title":"Diagnosis and initial management of Parkinon\u2019s disease","volume":"353","author":"Nutt","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1136\/jnnp.2007.131045","article-title":"Parkinson\u2019s disease: Clinical features and diagnosis","volume":"79","author":"Jankovic","year":"2008","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"659","DOI":"10.2522\/ptj.20140603","article-title":"Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation","volume":"96","author":"Peterson","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mancini, M., Curtze, C., Stuart, S., El-Gohary, M., McNames, J., Nutt, J.G., and Horak, F.B. (2018, January 18\u201321). The impact of freezing of gait on balance perception and mobility in community-living with Parkinson\u2019S disease. Proceedings of the 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Honolulu, HI, USA.","DOI":"10.1109\/EMBC.2018.8512910"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S1474-4422(11)70067-9","article-title":"Postural deformities in Parkinson\u2019s disease","volume":"10","author":"Doherty","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/mdc3.12437","article-title":"Clinical definition of camptocormia in Parkinson\u2019s disease","volume":"4","author":"Margraf","year":"2017","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/mdc3.12810","article-title":"Postural abnormalities in Parkinson\u2019s disease: An epidemiological and clinical multicenter study","volume":"6","author":"Tinazzi","year":"2019","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1002\/mdc3.13460","article-title":"Task Force Consensus on Nosology and Cut-Off Values for Axial Postural Abnormalities in Parkinsonism","volume":"9","author":"Tinazzi","year":"2022","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.parkreldis.2018.11.003","article-title":"Botulinum toxin for Pisa syndrome: An MRI-, ultrasound-and electromyography-guided pilot study","volume":"62","author":"Artusi","year":"2019","journal-title":"Park. Relat. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.parkreldis.2019.05.006","article-title":"Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson\u2019s disease: A single-blinded, randomized controlled trial","volume":"64","author":"Gandolfi","year":"2019","journal-title":"Park. Relat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1002\/mds.26829","article-title":"Pisa syndrome in Parkinson\u2019s disease: An integrated approach from pathophysiology to management","volume":"31","author":"Tinazzi","year":"2016","journal-title":"Mov. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Buckley, C., Alcock, L., McArdle, R., Rehman, R.Z.U., Del Din, S., Mazz\u00e0, C., Yarnall, A.J., and Rochester, L. (2019). The role of movement analysis in diagnosing and monitoring neurodegenerative conditions: Insights from gait and postural control. Brain Sci., 9.","DOI":"10.3390\/brainsci9020034"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101117","DOI":"10.1016\/j.arr.2020.101117","article-title":"Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis","volume":"62","author":"Quijoux","year":"2020","journal-title":"Ageing Res. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12891-019-2430-6","article-title":"The role of wearables in spinal posture analysis: A systematic review","volume":"20","author":"Simpson","year":"2019","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Panero, E., Dimanico, U., Artusi, C.A., and Gastaldi, L. (2021). Standardized biomechanical investigation of posture and gait in pisa syndrome disease. Symmetry, 13.","DOI":"10.3390\/sym13122237"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1007\/s10072-020-04319-3","article-title":"Video analysis of long-term effects of levodopa-carbidopa intestinal gel on gait and posture in advanced Parkinson\u2019s disease","volume":"41","author":"Fabbri","year":"2020","journal-title":"Neurol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.parkreldis.2018.06.013","article-title":"Consensus for the measurement of the camptocormia angle in the standing patient","volume":"52","author":"Margraf","year":"2018","journal-title":"Park. Relat. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.parkreldis.2019.10.024","article-title":"Validity of the wall goniometer as a screening tool to detect postural abnormalities in Parkinson\u2019s disease","volume":"69","author":"Tinazzi","year":"2019","journal-title":"Park. Relat. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.parkreldis.2020.01.012","article-title":"Quantitative assessment of posture in healthy controls and patients with Parkinson\u2019s disease","volume":"76","author":"Schlenstedt","year":"2020","journal-title":"Park. Relat. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hammadi, Y., Grondin, F., Ferland, F., and Lebel, L. (2022). Evaluation of Various State of the Art Head Pose Estimation Algorithms for Clinical Scenarios. Sensors, 22.","DOI":"10.3390\/s22186850"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cao, Z., Simon, T., Wei, S.E., and Sheikh, Y. (2017, January 21\u201326). Realtime multi-person 2d pose estimation using part affinity fields. Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition, Honolulu, HI, USA.","DOI":"10.1109\/CVPR.2017.143"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Moro, M., Marchesi, G., Hesse, F., Odone, F., and Casadio, M. (2022). Markerless vs. Marker-Based Gait Analysis: A Proof of Concept Study. Sensors, 22.","DOI":"10.3390\/s22052011"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lam, W.W., and Fong, K.N. (2022). The application of markerless motion capture (MMC) technology in rehabilitation programs: A systematic review and meta-analysis. Virtual Real., 1\u201316.","DOI":"10.1007\/s10055-022-00696-6"},{"key":"ref_26","first-page":"e13517","article-title":"Healthcare applications of single camera markerless motion capture: A scoping review","volume":"10","author":"Scott","year":"2022","journal-title":"Sport. Med. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"140","DOI":"10.14802\/jmd.21129","article-title":"Automatic Measurement of Postural Abnormalities with a Pose Estimation Algorithm in Parkinson\u2019s Disease","volume":"15","author":"Shin","year":"2022","journal-title":"J. Mov. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/s12984-021-00959-4","article-title":"Automated and accurate assessment for postural abnormalities in patients with Parkinson\u2019s disease based on Kinect and machine learning","volume":"18","author":"Zhang","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"110414","DOI":"10.1016\/j.jbiomech.2021.110414","article-title":"Assessment of spatiotemporal gait parameters using a deep learning algorithm-based markerless motion capture system","volume":"122","author":"Kanko","year":"2021","journal-title":"J. Biomech."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Artusi, C.A., Geroin, C., Imbalzano, G., Camozzi, S., Aldegheri, S., Lopiano, L., Tinazzi, M., and Bombieri, N. (Mov. Disord. Clin. Pract., 2023). Assessment of Axial Postural Abnormalities in Parkinsonism: Automatic Picture Analysis Software, Mov. Disord. Clin. Pract., early view.","DOI":"10.1002\/mdc3.13692"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1109\/TPAMI.2019.2929257","article-title":"OpenPose: Realtime Multi-Person 2D Pose Estimation Using Part Affinity Fields","volume":"43","author":"Cao","year":"2021","journal-title":"IEEE Trans. Pattern Anal. Mach. Intell."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/s12984-021-00933-0","article-title":"Concurrent validity of human pose tracking in video for measuring gait parameters in older adults: A preliminary analysis with multiple trackers, viewing angles, and walking directions","volume":"18","author":"Mehdizadeh","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_33","unstructured":"Lin, T.Y., Maire, M., Belongie, S., Hays, J., Perona, P., Ramanan, D., Doll\u00e1r, P., and Zitnick, C.L. (2014). Computer Vision\u2014ECCV 2014, Zurich, Switzerland, 6\u201312 September 2014, Springer International Publishing."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Andriluka, M., Pishchulin, L., Gehler, P., and Schiele, B. (2014, January 23\u201328). 2D Human Pose Estimation: New Benchmark and State of the Art Analysis. Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition (CVPR), Columbus, OH, USA.","DOI":"10.1109\/CVPR.2014.471"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.math.2008.06.002","article-title":"Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5","volume":"14","author":"Robinson","year":"2009","journal-title":"Man. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1109\/34.969114","article-title":"Fast approximate energy minimization via graph cuts","volume":"23","author":"Boykov","year":"2001","journal-title":"IEEE Trans. Pattern Anal. Mach. Intell."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"106242","DOI":"10.1016\/j.clineuro.2020.106242","article-title":"Therapeutic interventions for Pisa syndrome in idiopathic Parkinson\u2019s disease. A Scoping Systematic Review","volume":"198","author":"Etoom","year":"2020","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.apmr.2016.06.008","article-title":"Reliability and validity of nonradiologic measures of forward flexed posture in Parkinson disease","volume":"98","author":"Nair","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_39","unstructured":"BIPM, IEC, IFCC, ILAC, ISO, IUPAC, IUPAP, and OIML (2012). International Vocabulary of Metrology\u2014Basic and General Concepts and Associated Terms (VIM), Joint Committee for Guides in Metrology. [ 3rd. ed.]. JCGM 200:2012."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/6\/3193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:57:04Z","timestamp":1760122624000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/6\/3193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,16]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["s23063193"],"URL":"https:\/\/doi.org\/10.3390\/s23063193","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,16]]}}}