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Preview A nonlinear mixed effects directional model for the estimation of the rotation axes of the human ankle

TheAnnalsofAppliedStatistics 2010,Vol.4,No.4,1892–1912 DOI:10.1214/10-AOAS342 (cid:13)c InstituteofMathematicalStatistics,2010 A NONLINEAR MIXED EFFECTS DIRECTIONAL MODEL FOR THE ESTIMATION OF THE ROTATION AXES OF THE HUMAN ANKLE 1 1 By Mohammed Haddou, Louis-Paul Rivest1 and 0 2 Michael Pierrynowski n Universit´e Laval, Universit´e Laval and McMaster University a J This paper suggests a nonlinear mixed effects model for data 6 points in SO(3), the set of 3×3 rotation matrices, collected accord- ingtoarepeatedmeasuredesign.Eachsampleindividualcontributes ] asequenceofrotationmatricesgivingtherelativeorientationsofthe P right foot with respect totheright lower leg asits anklemoves.The A random effects are the five angles characterizing the orientation of t. the two rotation axes of a subject’s right ankle. The fixed parame- a ters are the average value of these angles and their variances within t s thepopulation. Thealgorithms tofitnonlinearmixed effectsmodels [ presented in Pinheiro and Bates (2000) are adapted to the new di- 1 rectional model. Theestimation of therandom effectsare ofinterest v sincetheygivepredictionsoftherotationaxesofanindividualankle. 3 TheperformanceofthesealgorithmsisinvestigatedinaMonteCarlo 0 study.Theanalysis oftwodatasetsispresented.Inthebiomechani- 2 calliterature,thereisnoconsensusonaninvivomethodtoestimate 1 thetworotationaxesoftheankle.Thenewmodelispromising.The 1. estimates obtained from a sample of volunteers are shown to be in 0 agreement with the clinically accepted results of Inman (1976), ob- 1 tained by manipulating cadavers. The repeated measure directional 1 model presented in this paper is developed for a particular appli- : cation. The approach is, however, general and might be applied to v other models provided that the random directional effects are clus- i X tered around their mean values. r a 1. Introduction. The human ankle joint complex has been modeled as a two fixed axis mechanism. It is the primary joint involved in the motion of the rearfoot with respect to the lower leg. The characterization of walking Received September2009; revised January 2010. 1Supported in part by the Natural Sciences and Engineering Research Council of Canada and of theCanada Research Chair in Statistical Sampling and Data Analysis. Key words and phrases. Mixed effects model, penalized likelihood, Bayesian analysis, directional data, rotation matrices, joint kinematics. This is an electronic reprint of the original article published by the Institute of Mathematical Statistics in The Annals of Applied Statistics, 2010,Vol. 4, No. 4, 1892–1912. This reprint differs from the original in pagination and typographic detail. 1 2 M. HADDOU,L.-P. RIVESTANDM. PIERRYNOWSKI Fig. 1. The deviation and inclination angles of the tibiotarsal (TT) and subtalar (ST) human ankle rotation axes. disordersassociated with cerebral palsy,clubfoot or flatfoot deformities uses altered externalmoments(torques)aboutthetworotation axesoftheankle. Anaccurateandreliabledeterminationoftheorientationofthesetwoaxesis important to successfully evaluate and treat patients with these conditions. There is no consensus, in the biomechanical literature, on a noninvasive method for estimating the location and orientation of these ankle axes in a live individual. The two rotation axes of the ankle can be recorded in an RFU coordi- nate system where the x-axis points Right, the y-axis goes Forward and the z-axis goes Up. Anatomically, plantarflexion–dorsiflexion occurs about the tibiotarsal, or tt axis, which is attached to the lower leg, while the subtalar, or st axis, attached to the calcaneus, is used for the supination-pronation motion of the foot. These two axes are presented in Figure 1. Their orien- tations are determined by four anatomical angles (ttinc, ttdev, stinc, stdev) giving the inclinations and the deviations of these two axes referenced to the RFU coordinate system. Using an average generic orientation for each axis results in substantial errors [Lewis et al. (2009)] because of an important between subject varia- tion in axis locations as characterized in Section 7.1 below. Several in vivo estimation methods have been proposed in biomechanical journals [see, for instance, van den Bogert, Smith and Nigg (1994) and Lewis et al. (2009)], but none was completely successful at estimating the angles in Figure 1. The poor numerical results obtained by Lewis, Sommer and Piazza (2006) led them to question the validity of the two-axis model for the ankle. MIXED EFFECTS DIRECTIONALMODEL 3 The in vivo estimation of the orientation of the two axes of the ankle is a statistical problem. The data set for one individual is a sequence of 3 3 × rotation matrices giving the relative orientation of the foot of the subject withrespecttoitslowerlegasitsanklemovesupanddown,rightandleft,as much as possible. Rivest, Baillargeon and Pierrynowski (2008) and van den Bogert, Smith and Nigg (1994) provide more details about data collection. FollowingvandenBogert,SmithandNigg(1994),Rivest,Baillargeon and Pierrynowski (2008) developed a statistical model for analyzing the rotation data collected on a single ankle. Its parameters are the four angles defined in Figure 1 and a fifth one for the relative position of the two rotation axes. This model fits well; the residual standard deviations reported in Rivest, Baillargeon and Pierrynowski (2008) are around one degree. For a subject whose ankle has an average range of motion, the estimates are, however, not repeatable. Two data sets collected on the same ankle in similar conditions can give different estimated angles. This occurs because the likelihood func- tiondoesnothaveaclearmaximum;ithasaplateauandsomeanglescannot be estimated independently of the others. Indeed, Rivest, Baillargeon and Pierrynowski(2008)demonstrate that only three parameters can bereliably estimated in a subject with an average ankle range of motion. Considering the small range of the residual angles, a failure of the two-axis model is an unlikely cause for the poor repeatability of the results. This paper suggests methods to improve the numerical stability of the estimates derived from the ankle model. A penalized likelihood is proposed for estimating the parameters. The penalty is obtained by assuming a prior multivariate normal distribution for the five angle parameters. When the mean and the variance covariance matrix of the prior distribution are not known, one is confronted with a nonlinear mixed effects directional model whose parameters can beestimated using ankle’s data collected on a sample ofvolunteers.Twonumericalalgorithmstofitthismodelareproposed.Their performances are evaluated in a Monte Carlo experiment; two data sets are then analyzed using the new nonlinear mixed effects directional model. Nonlinear mixed effects vary with the parametrization of the random effects. Thus, the first step of the analysis is to parameterize the model of Rivest,Baillargeon andPierrynowski(2008)intermsoftheanglespresented in Figure 1 and to derive inference techniques using this parametrization. These procedures are then generalized to a Bayesian setting obtained by multiplyingthelikelihood bythepriordistributionofthemodelparameters. The algorithms of Lindstrom and Bates (1990) [see also Pinheiro and Bates (2000)] for fitting nonlinear mixed effects models are then adapted to the new directional model. Nonlinear mixed effects and Bayesian models with concentrated priordis- tributions could potentially be used in many problems of directional statis- tics. These techniques could, for instance, beapplied to the sphericalregres- sion model considered by Kim (1991) and Bingham, Chang and Richards 4 M. HADDOU,L.-P. RIVESTANDM. PIERRYNOWSKI (1992) and to the directional one way ANOVA model of Rancourt, Rivest and Asselin (2000) to characterize the between subject variability of the mean rotation. This new statistical methodology has important applications in biome- chanics. By fitting a nonlinear mixed effects directional model to data col- lected onasampleof volunteers, oneis abletoestimate themean values and the between subject variances of the five anatomical angles in the popula- tion. These estimates are found to be close to the clinically accepted results obtained by Inman (1976) who used direct measurements from cadaveric feet. This provides an empirical validation of the two-axis model of van den Bogert, Smith and Nigg (1994) for the ankle. Thenew model also allows the analysis of the rotation data collected by Pierrynowski et al. (2003) which compared the orientations of the subtalar axis of two groups of individuals classified according to their lower extremity injuries. Finally, the penalized predictions associated to the mixed effect model are shown to be more sta- ble than the estimates obtained by maximizing the standard unpenalized likelihood for one subject. 2. Parameterizationofunitvectorsandofrotationmatricesusinganatom- ical angles. Let A and B be 3 1 unit vectors giving the tibiotarsal 1 2 × and the subtalar rotation axes in a coordinate system defined according to the RFU convention. These unit vectors are first expressed in terms of the anatomical angles. Then the Cardan angle decomposition for a 3 3 rota- × tion matrix is briefly reviewed. This section uses the arctan function with two arguments, such that arctan(a,b) is the angle whose sine and cosine are given by a/√a2+b2 and b/√a2+b2, respectively. First consider the tibiotarsal axis, A =(A ,A ,A )⊤, where “⊤” de- 1 11 21 31 notes a matrix transpose. Formally, the anatomical angles are defined as ttinc =t = arctan(A ,A ) and ttdev =t =arctan(A ,A ). Without 1 31 11 2 21 11 − loss of generality, we assume that the first coordinate of A is positive. A 1 general expression for unit vectors in the half unit sphere is cos(t ) 1 1 (2.1) A = cos(t )tan(t ) , t ,t [ π/2,π/2), 1 1 2 1 2 D   ∈ − t sin(t ) 1 −   where D = 1+cos2(t )tan2(t ). In a similar manner, one can param- t 1 2 eterize the subtalar axis in terms of the anatomical angles stinc = s = p 1 arctan(B ,B ) and stdev =s = arctan(B ,B ) as follows, 32 22 2 12 22 − cos(s )tan(s ) 1 − 1 2 (2.2) B = cos(s ) , s ,s [ π/2,π/2), 2 1 1 2 D   ∈ − s sin(s ) 1   MIXED EFFECTS DIRECTIONALMODEL 5 where D = 1+cos2(s )tan2(s ). s 1 2 The set SO(3) of 3 3 rotation matrices is a three-dimensional manifold p × whose properties are reviewed in McCarthy (1990), Chirikjian and Kyatkin (2001)andLeo´n,Mass´eandRivest(2006).ThispaperusestheCardanangle parametrization with the X Z Y convention. It expresses an element of − − SO(3) as a function of the Cardan angles α [ π,π), γ [ π/2,π/2) and ∈ − ∈ − φ [ π,π) as ∈ − 1 0 0 cosγ sinγ 0 cosφ 0 sinφ − R= 0 cosα sinα sinγ cosγ 0 0 1 0  −    0 sinα cosα 0 0 1 sinφ 0 cosφ − (2.3)     cosγcosφ sinγ cosγsinφ − = cosαcosγ ,  ··· ···  sinαcosγ ··· ···   where stands for complex trigonometric expressions that are not used ··· in the sequel. We also write R = R(α,x) R(γ,z) R(φ,y), where the × × arguments of R(, ) are the angle and the axis of the rotation respectively. · · The model presented in the next section uses rotation matrices, A(t ,t ) 1 2 and B(s ,s ), whose first and second columns are respectively equal to A 1 2 1 and B . These matrices are given by 2 A(t ,t )=R(t ,y)R[arctan cos(t )tan(t ),1 ,z] 1 2 1 1 2 { } cos(t ) cos2(t )tan(t ) sin(t )D 1 1 − 1 2 1 t = cos(t )tan(t ) 1 0 1 2 D   t sin(t ) sin(t )cos(t )tan(t ) cos(t )D 1 1 1 2 1 t −   and B(s ,s )=R(s ,x)R[arctan cos(s )tan(s ),1 ,z] 1 2 1 1 2 { } 1 cos(s )tan(s ) 0 1 − 1 2 = cos2(s )tan(s ) cos(s ) sin(s )D , 1 2 1 1 s D  −  s sin(s )cos(s )tan(s ) sin(s ) cos(s )D 1 1 2 1 1 s   where D and D are defined in (2.1) and (2.2), respectively. t s 3. The model for estimating the rotation axes of a single ankle. This section expresses the model of Rivest, Baillargeon and Pierrynowski (2008) for the estimation of the anatomical angles for a single subject in terms of the rotation matrices A(t ,t ) and B(s ,s ). The data set is a sequence of 1 2 1 2 time ordered 3 3 rotation matrices R :i=1,...,n . The model for R i i × { } involves the four anatomical angles, rotation angles α :i=1,...,n and i { } φ :i=1,...,n in [ π,π) about the two rotation axes and the angle γ i 0 { } − ∈ 6 M. HADDOU,L.-P. RIVESTANDM. PIERRYNOWSKI ( π/2,π/2), related to the relative position of the two axes. The predicted − value Ψ for R is given by i i (3.1) Ψ =A(t ,t )R(α ,x)R(γ ,z)R(φ ,y)B(s ,s )⊤. i 1 2 i 0 i 1 2 The errors are assumed to have a symmetric Fisher–von Mises matrix distribution with density f(E)=exp κtr(E) /c , E SO(3), where c is κ κ { } ∈ a normalizing constant; see Mardia and Jupp (2000). If the parameter κ is assumed to be large so that the error rotations are clustered around the identity matrix I , one has 3 0 ε ε − 3 2 1 (3.2) E=I + ε 0 ε +O , 3 3 1 p  −  κ ε2 ε1 0 (cid:18) (cid:19) −   where the entries ε , ε , ε of the skew-symmetric matrix have independent 1 2 3 0,1/(2κ) distributions;1/(2κ) iscalledtheresidualvariance.Themodel N{ } postulatesthatR =Ψ E ,fori=1,...,n.ThelikelihoodisL[t ,t ,s ,s ,γ , i i i 1 2 1 2 0 κ, α , φ ]= f(Ψ ⊤R ). Rivest, Baillargeon and Pierrynowski (2008) { i} { i} i i i show that the angles α and φ can be profiled out of the likelihood. i i Q { } { } Indeed, L[t ,t ,s ,s ,γ ,κ, α , φ ] L (t ,t ,s ,s ,γ ,κ) 1 2 1 2 0 i i p 1 2 1 2 0 { } { } ≤ (3.3) n 1 = exp κ 2cos(θz γ )+1 , cn { i − 0 } κ " i=1 # X whereθz = arcsin(A ⊤R B )istheZ-CardanangleofA(t ,t )⊤R B(s ,s ) i − 1 i 2 1 2 i 1 2 in the X Z Y convention; see (2.3). − − Several methods are available to maximize (3.3). However, for the imple- mentation of the mixed effects directional model, a closed form expression for the score vector for β=(t ,t ,s ,s ,γ )⊤ is needed. This is derived now. 1 2 1 2 0 Observe that cos(θ)=1 2sin2(θ/2), where θ/2 can be assumed to lie in − the interval [ π/2,π/2). The log profile likelihood is equal to − n θz γ logL (t ,t ,s ,s ,γ ,κ)= 4κ sin2 i − 0 nlogc +3nκ. p 1 2 1 2 0 κ − 2 − i=1 (cid:18) (cid:19) X The score for γ is easily evaluated, viz. 0 ∂ n θz γ θz γ logL (t ,t ,s ,s ,γ ,κ)=4κ sin i − 0 cos i − 0 . p 1 2 1 2 0 ∂γ 2 2 0 i=1 (cid:18) (cid:19) (cid:18) (cid:19) X The score for the four remaining parameters involve the following partial derivatives that are evaluated usingelementary methods. Theproperty that MIXED EFFECTS DIRECTIONALMODEL 7 the partial derivatives of a unit vector and the unit vector itself are orthog- onal was used to get the following results: ∂ sin(t )tan(t ) 1 1 2 A = A A , ∂t 1 − D2 2− D 3 1 t t ∂ cos(t ) 1+tan2(t ) A = 1 { 2 }A , ∂t 1 D2 2 2 t ∂ sin(s )tan(s ) 1 B = 1 2 B + B , ∂s 2 D2 1 D 3 1 s s ∂ coss 1+tan2(s ) 1 2 B = { }B . ∂s 2 − D2 1 2 s Since θz = arcsin(A ⊤R B ), the score for t is given by i − 1 i 2 1 ∂ n θz γ θz γ logL (t ,t ,s ,s ,γ ,κ)= 4κ sin i − 0 cos i − 0 p 1 2 1 2 0 ∂t − 2 2 1 i=1 (cid:18) (cid:19) (cid:18) (cid:19) X 1 ∂ − A ⊤R B . 1 i 2 × 1 (A1⊤RiB2)2∂t1 − This can be evaluated using the previouspexpressions for the partial deriva- tives. Repeating this for the other anatomical angles leads to ∂ n θz γ θz γ ∂ logL (β,κ)= 4κ sin i − 0 cos i − 0 (θz γ ) ∂β p − 2 2 ∂β i − 0 i=1 (cid:18) (cid:19) (cid:18) (cid:19) (3.4) X n θz γ = 4κ sin i − 0 X , i − 2 i=1 (cid:18) (cid:19) X where cos (θz γ )/2 X = { i − 0 } i − 1 (A ⊤R B )2 1 i 2 (3.5) − p sin(t )tan(t ) 1 1 2 A ⊤R B A ⊤R B − D2 2 i 2− D 3 i 2 t t  cos(t ) 1+tan2(t )  1 { 2 }A ⊤R B  D2 2 i 2   t  × sin(s1D)t2an(s2)A1⊤RiB1+ D1 A1⊤RiB3 .  s s   cos(s ) 1+tan2(s )   1 { 2 }A ⊤R B   − D2 1 i 1   s   1 (A ⊤R B )2   1 i 2  −   p 8 M. HADDOU,L.-P. RIVESTANDM. PIERRYNOWSKI Evaluated at β+δ(β), where δ(β) is a 5 1 vector with entries close to 0, × the score vector (3.4) is n θz γ 1 4κ sin i − 0 X + X X ⊤δ(β) i i i − 2 2 i=1(cid:26) (cid:18) (cid:19) (cid:27) X +O( δ(β) 2)+O(max[ sin (θz γ )/2 δ(β) ]). k k | { i − 0 }|k k One can consider that the last two terms are negligible since the residuals (θz γ ) are small. This is standard in the large κ asymptotics used to i − 0 approximate thesamplingdistributionsof estimators in adirectional model: both βˆ β and the errors ε in (3.2) are assumed to be O(1/√κ); see, j − for instance, Rivest and Chang (2006). Equating this to 0 yields a simple updating formula. Given its current value β, the updated value is β+δ(β), where n −1 n θz γ δ(β)= X X ⊤ 2sin i − 0 X . i i i − 2 ! i=1 i=1(cid:26) (cid:18) (cid:19) (cid:27) X X This calculation can be carried out by regressing the residual vector [2sin (θz γ )/2 ] on the explanatory variables X . Theorem 1 of Rivest, { i − 0 } { i} Baillargeon and Pierrynowski (2008) holds and, as κ goes to , the max- ∞ imum likelihood estimator βˆ is approximately normally distributed. Once the model is fitted, the residual variance 1/(2κ) can be estimated using the sum of the squared residuals, n 1 1 = 4sin2 (θˆz γˆ )/2 , 2κˆ n { i − 0 } i=1 X where the residual angle θˆz = arcsin(A ⊤R B ) is the Z-Cardan angle of i − 1 i 2 A⊤R B in the X Z Y convention. Using Grood and Suntay (1983) clin- i − − ical interpretation, rotations of angle θbˆz occbur about a floating axis that { i} ibs orthbogonal to both the tt and the st axes. Plots of these angles appear in Figure 2 of Rivest, Baillargeon and Pierrynowski (2008); their residual stan- dard deviation, 1/2κˆ, is about one degree. The distribution of the resid- uals [2sin (θz γ )/2 ] is usually approximately normal; the normality { { i −p 0 }} assumption in (3.2) is not violated for most of the data sets investigated. Thus, the proposed model fits well to the ankle data. Many individuals have a limited ankle range of motion; the domains for angles α and φ in(3.1)arethereforelimited.Thismakes theestimates i i { } { } of the anatomical angles numerically unstable. There can be important dif- ferences between the estimates calculated on two data sets collected in suc- cession on the same ankle; see Rivest, Baillargeon and Pierrynowski (2008). Thus, individual measurements do not allow the estimation of a complete MIXED EFFECTS DIRECTIONALMODEL 9 set of anatomical angles. This suggests to borrow strength from other indi- viduals and to consider a Bayesian model whose prior distribution penalizes extreme parameter values. 4. A Bayesian ankle model. Assume, for now, that the residual variance 1/(2κ) is known and that the 5 1 vector of anatomical angles β is ran- × dom and has a (β ,Σ ), where β is the average vector of anatomical 5 0 0 0 N angles within the population and the 5 5 variance covariance matrix Σ 0 × characterizes the variability of the anatomical angles within the population; both are assumed to beknown.Elements of β and Σ could beset equal to 0 0 the values of Inman (1976), who studied the variability of these angles. We assume that Σ is O(1/(2κ)), thus, there is a fixed 5 5 upper triangular 0 matrix ∆ such that Σ =∆−1(∆−⊤)/(2κ), where ∆×−⊤ is the inverse of 0 0 0 0 0 ∆⊤. This section presents an algorithm to derive the mode of the posterior 0 distribution of β and suggests an approximation for its posterior distribu- tion. The posterior distribution of β is proportional to n θz γ exp κ 4sin2 i − 0 +(β β )⊤∆ ⊤∆ (β β ) − 2 − 0 0 0 − 0 " ( )# i=1 (cid:18) (cid:19) X =exp κSSE(β) . {− } The posterior mode β is the value of β that minimizes SSE. It can be evaluated by adapting the regression algorithm of Section 3 to the Bayesian framework. The vectobr of partial derivatives of SSE with respect to β is easily derived, ∂ n θz γ (4.1) SSE(β)=4 sin i − 0 X +2∆ ⊤∆ (β β ), ∂β 2 i 0 0 − 0 i=1 (cid:18) (cid:19) X where the vector of partial derivatives X is defined by (3.5). i Proceeding as in Section 3, one constructs an algorithm for minimizing SSE. The current value β is updated to β+δ(β), where n −1 n θz γ δ(β)= X X ⊤+∆ ⊤∆ 2sin i − 0 X i i 0 0 i − 2 ! " i=1 i=1(cid:26) (cid:18) (cid:19) (cid:27) X X +∆ ⊤∆ (β β ) . 0 0 − 0 # An alternative expression for the updated value is n −1 β+δ(β)= X X ⊤+∆ ⊤∆ i i 0 0 ! i=1 X 10 M. HADDOU,L.-P. RIVESTANDM. PIERRYNOWSKI n θz γ 2sin i − 0 +X ⊤β X +∆ ⊤∆ β . × − 2 i i 0 0 0 " # i=1(cid:26) (cid:18) (cid:19) (cid:27) X An approximation to the posterior distribution of the anatomical angles is given next. Proposition 1. As κ , the posterior distribution for β satisfies →∞ n −1 √2κ(β βˆ) 0, Xˆ Xˆ ⊤+∆ ⊤∆ , 5 i i 0 0 − ∼N ( ! ) i=1 X where Xˆ denotes the 5 1 vector of partial derivatives defined by (3.5) and i × evaluated at βˆ. Theposteriordensityofδ=√2κ(β βˆ)isproportionaltoexp κSSE(βˆ+ − {− δ/√2κ) . The result is proved by taking a second-order Taylor series ex- } pansion around δ=0. The first order derivatives are null and the variance covariance matrix of Proposition 1 is obtained by dropping the o 1/(2κ) { } terms in the matrix of second-order derivatives. Wenowstudysomefrequentistpropertiesofβˆ.Letβ(t) bethetruevalues of the anatomical angles for the individual under consideration. Thus, β(t) is a realization of the (β ,Σ ) prior distribution, such that β(t) β N5 0 0 k − 0k is O(1/√2κ). The difference βˆ β(t) is O(1/√2κ). The leading term of − this difference consists of a linear combination of individual experimental errorsandof thepenalty associated tothepriordistribution.Togetaclosed form expression, one can proceed as in Appendix B of Rivest, Baillargeon and Pierrynowski (2008). It suffices to carry out a first-order Taylor series expansion of (4.1) in terms of the difference δ(β) = β β(t) and of the − experimental errors. This yields ∂ SSE(β(t)+δ(β)) ∂β n n (4.2) =2 ǫ X(t)+ X(t)X(t)Tδ(β)+∆ ⊤∆ (δ(β)+β(t) β ) i i i i 0 0 − 0 ( ) i=1 i=1 X X +O(1/κ), where ǫ is a (0,1/(2κ)) randomvariable thatdependson theerror matrix i N (t) E , and X denotes the vector of partial derivatives X evaluated at the i i i true value β(t), with R set equal to Ψ in (3.5). Now βˆ corresponds to the i i value of δ(β) for which (4.2) is null, thus, n −1 βˆ =β(t) X(t)X(t)T +∆ ⊤∆ − i i 0 0 ! i=1 X

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