## 4 Discussion  
In this study, we present an approach based on the MBD method to monitor individuals using gait analysis. This approach was applied to 21 heterogeneous patients with hemiplegic spasticity who had received treatment with botulinum toxin. The results for each patient were interpreted considering'real' changes (i.e., considering those changes that exceeded the threshold \(\delta\) by degrees of'very likely' or above (>95%) probability). Finally, the patients were classified according to their overall progress, and 10 patients showed overall improvement, five patients showed overall impairment and six patients did not show any overall change. Generating objective information for each individual patient was crucial [63]. The MBD approach provided useful, graphic information to improve the clinical decision-making process. When the investigated population displays a wide range of mobilities and clinical statuses, the importance of personalizing treatment and assessment become clear. These conclusions coincide with the [PERSON] et al. [7] statement, who ensured that individual gait analysis monitoring has key advantages in daily clinical practice in the treatment of pathologies such as spasticity. Comparing the approach here with others in the field, we did not find any other study that used the idea of gait as a cyclical movement to analyze individual patients. This feature has generally been applied only to average these cycles to achieve a more stable or representative cycle. However, we did find other studies sharing the objective of assessing individuals [18]. For instance, studies by [PERSON] and [PERSON] [64], [PERSON] et al. [65], and [PERSON] et al. [17] assessed MoCap systems to discover whether they could adequately monitor patients, which was our intention as well. It is important to highlight that the approach does not determine whether improvement or impairment of a patient has occurred; that is the ultimate responsibility of a physician. The judgement of a specialist is always necessary to evaluate the results of this method, and one cannot separate the specialist from the method. The full name of the statistical method employed in this study, MBD, includes the word 'decisions', but this does not imply that the method alone facilitates decision-making. In addition, we found the technology based on wireless IMUs to be a valid alternative to the gold-standard optical MoCap technology [66; 67; 68; 69; 70]. Although IMUs are slightly less accurate than optical MoCap systems due to drift errors, they are more economical and portable, do not require a camera infrastructure and do not present shadowing problems. Therefore, they are a suitable choice in a hospital environment in which substantial limitations exist in terms of the dedicated spaces required for optical systems [7; 17]. On this subject, we highlight the operation of the MH-IMU system used in this study [17]. This instrumentation performed adequately in patients with hemiplegic spasticity. The deactivation of the IMUs' magnetometers had significant implications since it eliminated the need for a magnetically controlled environment. Additionally, the algorithm that the system incorporates to detect gait events performed adequately in the patients of our study, which was an important challenge due to the random nature of their gait patterns. It can be assured that the MBD approach is a more realistic method than null-hypothesis significance tests [71], but it requires the making of important, logical decisions regarding the threshold \(\delta\) during the application process [37]. Our threshold \(\delta\) comprised [PERSON]'s limits of agreement [51]. These limits depend on patient variability, which is one of the most important sources of error when assessing changes in this population, and which make this method realistic. The MBD approach requires the making of important, logical decisions regarding the threshold \(\delta\) during the application process [37].