Artificial neural network model for the generation of muscle activation patterns for human locomotion.

Skilled locomotor behaviour requires information from various levels within the central nervous system (CNS). Mathematical models have permitted researchers to simulate various mechanisms in order to understand the organization of the locomotor control system. While it is difficult to adequately characterize the numerous inputs to the locomotor control system, an alternative strategy may be to use a kinematic movement plan to represent the complex inputs to the locomotor control system based on the possibility that the CNS may plan movements at a kinematic level. We propose the use of artificial neural network (ANN) models to represent the transformation of a kinematic plan into the necessary motor patterns. Essentially, kinematic representation of the actual limb movement was used as the input to an ANN model which generated the EMG activity of 8 muscles of the lower limb and trunk. Data from a wide variety of gait conditions was necessary to develop a robust model that could accommodate various environmental conditions encountered during everyday activity. A total of 120 walking strides representing normal walking and ten conditions where the normal gait was modified in terms of cadence, stride length, stance width or required foot clearance. The final network was assessed on its ability to predict the EMG activity on individual walking trials as well as its ability to represent the general activation pattern of a particular gait condition. The predicted EMG patterns closely matched those recorded experimentally, exhibiting the appropriate magnitude and temporal phasing required for each modification. Only 2 of the 96 muscle/gait conditions had RMS errors above 0.10, only 5 muscle/gait conditions exhibited correlations below 0.80 (most were above 0.90) and only 25 muscle/gait conditions deviated outside the normal range of muscle activity for more than 25% of the gait cycle. These results indicate the ability of single network ANNs to represent the transformation between a kinematic movement plan and the necessary muscle activations for normal steady state locomotion but they were also able to generate muscle activation patterns for conditions requiring changes in walking speed, foot placement and foot clearance. The abilities of this type of network have implications towards both the fundamental understanding of the control of locomotion and practical realizations of artificial control systems for use in rehabilitation medicine.     

A mobile gait monitoring system for abnormal gait diagnosis and rehabilitation: a pilot study for Parkinson disease patients

Conventional gait rehabilitation treatment does not provide quantitative information on abnormal gait kinematics, and the match of the intervention strategy to the underlying clinical presentation may be limited by clinical expertise and experience. Also the effect of rehabilitation treatment may be reduced as the rehabilitation treatment is achieved only in a clinical setting. In this paper, a mobile gait monitoring system (MGMS) is proposed for the diagnosis of abnormal gait and rehabilitation. The proposed MGMS consists of Smart Shoes and a microsignal processor with a touch screen display. It monitors patients' gait by observing the ground reaction force (GRF) and the center of GRF, and analyzes the gait abnormality. Since visual feedback about patients' GRFs and normal GRF patterns are provided by the MGMS, patients can practice the rehabilitation treatment by trying to follow the normal GRF patterns without restriction of time and place. The gait abnormality proposed in this paper is defined by the deviation between the patient's GRFs and normal GRF patterns, which are constructed as GRF bands. The effectiveness of the proposed gait analysis methods with the MGMS has been verified by preliminary trials with patients suffering from gait disorders.     

Comparing electro- and mechano-myographic muscle activation patterns in self-paced pediatric gait

Electromyography (EMG) is the standard modality for measuring muscle activity. However, the convenience and availability of low-cost accelerometer-based wearables makes mechanomyography (MMG) an increasingly attractive alternative modality for clinical applications. Literature to date has demonstrated a strong association between EMG and MMG temporal alignment in isometric and isokinetic contractions. However, the EMG-MMG relationship has not been studied in gait. In this study, the concurrence of EMG- and MMG-detected contractions in the tibialis anterior, lateral gastrocnemius, vastus lateralis, and biceps femoris muscles were investigated in children during self-paced gait. Furthermore, the distribution of signal power over the gait cycle was statistically compared between EMG-MMG modalities. With EMG as the reference, muscular contractions were detected based on MMG with balanced accuracies between 88 and 94% for all muscles except the gastrocnemius. MMG signal power differed from that of EMG during certain phases of the gait cycle in all muscles except the biceps femoris. These timing and power distribution differences between the two modalities may in part be related to muscle fascicle length changes that are unique to muscle motion during gait. Our findings suggest that the relationship between EMG and MMG appears to be more complex during gait than in isometric and isokinetic contractions.     

Simultaneous Scalp Electroencephalography (EEG), Electromyography (EMG), and Whole-body Segmental Inertial Recording for Multi-modal Neural Decoding

Recent studies support the involvement of supraspinal networks in control of bipedal human walking. Part of this evidence encompasses studies, including our previous work, demonstrating that gait kinematics and limb coordination during treadmill walking can be inferred from the scalp electroencephalogram (EEG) with reasonably high decoding accuracies. These results provide impetus for development of non-invasive brain-machine-interface (BMI) systems for use in restoration and/or augmentation of gait- a primary goal of rehabilitation research. To date, studies examining EEG decoding of activity during gait have been limited to treadmill walking in a controlled environment. However, to be practically viable a BMI system must be applicable for use in everyday locomotor tasks such as over ground walking and turning. Here, we present a novel protocol for non-invasive collection of brain activity (EEG), muscle activity (electromyography (EMG)), and whole-body kinematic data (head, torso, and limb trajectories) during both treadmill and over ground walking tasks. By collecting these data in the uncontrolled environment insight can be gained regarding the feasibility of decoding unconstrained gait and surface EMG from scalp EEG.     

Literature Review and Comparison of Two Statistical Methods to Evaluate the Effect of Botulinum Toxin Treatment on Gait in Children with Cerebral Palsy

Aim

This study aimed at comparing two statistical approaches to analyze the effect of Botulinum Toxin A (BTX-A) treatment on gait in children with a diagnosis of spastic cerebral palsy (CP), based on three-dimensional gait analysis (3DGA) data. Through a literature review, the available expert knowledge on gait changes after BTX-A treatment in children with CP is summarized.

Methods

Part 1—Intervention studies on BTX-A treatment in children with CP between 4–18 years that used 3DGA data as an outcome measure and were written in English, were identified through a broad systematic literature search. Reported kinematic and kinetic gait features were extracted from the identified studies. Part 2—A retrospective sample of 53 children with CP (6.1 ± 2.3years, GMFCS I-III) received 3DGA before and after multilevel BTX-A injections. The effect of BTX-A on gait was interpreted by comparing the results of paired samples t-tests on the kinematic gait features that were identified from literature to the results of statistical parametric mapping analysis on the kinematic waveforms of the lower limb joints.

Results

Part 1–53 kinematic and 33 kinetic features were described in literature. Overall, there is no consensus on which features should be evaluated after BTX-A treatment as 49 features were reported only once or twice. Part 2—Post-BTX-A, both statistical approaches found increased ankle dorsiflexion throughout the gait cycle. Statistical parametric mapping analyses additionally found increased knee extension during terminal stance. In turn, feature analyses found increased outtoeing during stance after BTX-A.

Conclusion

This study confirms that BTX-A injections are a valuable treatment option to improve gait function in children with CP. However, different statistical approaches may lead to different interpretations of treatment outcome. We suggest that a clear, definite hypothesis should be stated a priori and a commensurate statistical approach should accompany this hypothesis.     

Reliability and sources of variability of 3D kinematics and electromyography measurements to assess newly-acquired gait in toddlers with typical development and unilateral cerebral palsy

The aim was to 1) determine intersession and intertrial reliability and 2) assess three sources of variability (intersubject, intersession and intertrial) of lower limb kinematic and electromyographic (EMG) variables during gait in toddlers with typical development (TD) and unilateral cerebral palsy (UCP) (age <3 years, independent walking experience ≤6 months). Gait kinematics and surface EMG were recorded in 30 toddlers (19 TD and 11 UCP), during two, 3D-motion capture sessions. Standard error of measurement (SEM) between trials (gait cycles) of the same session and between sessions was calculated to assess reliability. Standard deviations (SD) between subjects, sessions and trials were calculated to estimate sources of variability. Sixty-four percent of kinematic SEM-values were acceptable (2°-5°). Frontal plane measurements were most reliable (SEM 2°-4.6°). In toddlers with UCP, EMG variables were most reliable for affected side, distal muscles. Intrinsic (intertrial and intersubject) variability was high, reflecting both motor immaturity and the high variability of toddler gait patterns. In toddlers with UCP, variability was amplified by motor impairment and delayed motor development. 3D gait analysis and surface EMG are partially reliable tools to study individual gait patterns in toddlers in clinical practice and research, although some variables must be interpreted with caution.     

Assessment of wavelet analysis of gait in children with typical development and cerebral palsy

The objective of this study was to examine the use of the continuous wavelet transform (CWT) on surface electromyographic (sEMG) signals acquired from the lower extremity muscles during gait in children with typical development (TD) and cerebral palsy (CP). This was done to explore the possibility of developing a quantitative assessment scale of motor function based on time-frequency information. An initial study was conducted on retrospective gait data from three children, matched in gender and in anthropometric variables but with differing levels of walking ability. EMG data were extracted from five lower extremity muscles to assess the degrees of differentiation. The data were processed using the CWT to derive an average scalogram, from which the instantaneous mean frequency (IMNF) was calculated. Principal component analysis was used to assess the differences between the curves. Preliminary results indicated that for select lower extremity muscles, there was a significant deviation in the IMNF curves in the child with CP as compared to the child with TD. Furthermore, as motor impairment increased, total percent explained variance to the TD curves decreased. This suggests that it might be possible to derive a physiologically based quantitative index for assessing motor function and for assessing clinical treatments in CP using the wavelet analysis.     

Comparison of Clinical Characteristics and Treatment Outcomes of Children Selected for Treatment of Severe Acute Malnutrition Using Mid Upper Arm Circumference and/or Weight-for-Height Z-Score

Objectives

Debate for a greater role of mid-upper arm circumference (MUAC) measures in nutritional programming continues, but a shift from therapeutic feeding programs admitting children using MUAC and/or weight-for-height Z (WHZ) to a new model admitting children using MUAC only remains complicated by limited information regarding the clinical profile and response to treatment of children selected by MUAC vs. WHZ. To broaden our understanding of how children identified for therapeutic feeding by MUAC and/or WHZ may differ, we aimed to investigate differences between children identified for therapeutic feeding by MUAC and/or WHZ in terms of demographic, anthropometric, clinical, and laboratory and treatment response characteristics.

Methods

Using secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of MUAC< 115 mm vs. children that are admitted under current admission criteria (WHZ< -3 and/or MUAC< 115 mm) but would be excluded from a program that used a single MUAC< 115 mm admission criterion. We assessed differences between groups using multivariate regression, employing linear regression for continuous outcomes and log-binomial regression for dichotomous outcomes.

Results

We found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC< 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program.

Conclusions

A single anthropometric admission criterion of MUAC < 115 mm did not differentiate well between children in terms of clinical or laboratory measures or program outcomes in this context. If nutritional programming is to use a single MUAC-based criterion for admission to treatment, further research and program experience can help to identify the most appropriate criterion in a broad range of contexts to target children in most urgent need of treatment.     

Online gait event detection using a large force platform embedded in a treadmill

Gait research and clinical gait training may benefit from movement-dependent event control, that is, technical applications in which events such as obstacle appearance or visual/acoustic cueing are (co)determined online on the basis of current gait properties. A prerequisite for successful gait-dependent event control is accurate online detection of gait events such as foot contact (FC) and foot off (FO). The objective of the present study was to assess the feasibility of online FC and FO detection using a single large force platform embedded in a treadmill. Center-of-pressure, total force output and kinematic data were recorded simultaneously in 12 healthy participants. Online FC and FO estimates and spatial and temporal gait parameters estimated from the force platform data-i.e., center-of-pressure profiles-were compared to offline kinematic counterparts, which served as the gold standard. Good correspondence was achieved between online FC detections using center-of-pressure profiles and those derived offline from kinematic data, whereas FO was detected 31ms too late. A good relative and absolute agreement was achieved for both spatial and temporal gait parameters, which was improved further by applying more fine-grained FO estimation procedures using characteristic local minima in the total force output time series. These positive results suggest that the proposed system for gait-dependent event control may be successfully implemented in gait research as well as gait interventions in clinical practice.     

Reflections on clinical gait analysis

Clinical gait analysis allows the measurement and assessment of walking biomechanics, which facilitates the identification of abnormal characteristics and the recommendation of treatment alternatives. The predominant methods for this analysis currently include the tracking of external markers placed on the patient, the monitoring of patient/ground interaction (e.g. ground reaction forces), and the recording of muscle electromyographic (EMG) activity, all during gait. These data allow the computation of stride and temporal parameters, joint/segment kinematics, joint kinetics, and EMG plots that are used to gain a better understanding of a patient's walking difficulties. Gait interpretation involves a systemic evaluation of each of these types of data, noting both corroborating and conflicting information while identifying functionally significant deviations from the normal. Understanding the etiology of these abnormalities allows the formulation of a treatment plan that may involve physical therapy, bracing, and/or surgery. This process is challenging because of the complexity of the motion, neuromuscular involvement of the patient (e.g. dynamic spasticity), variability of treatment outcome, and on occasion, uncertainty about the quality of the gait data. The experience of the interpretation team with respect to gait biomechanics, a particular patient population, and the effectiveness of different treatment modalities is the principal determinant of the success of this approach. The clinical gait analysis process continues to evolve positively. It has become more comprehensive and meaningful because of an improved understanding of normal gait biomechanics and more rigorous data collection/reduction protocols that complement accumulated clinically relevant experience.     

Kinematic analysis quantifies gait abnormalities associated with lameness in broiler chickens and identifies evolutionary gait differences

This is the first time that gait characteristics of broiler (meat) chickens have been compared with their progenitor, jungle fowl, and the first kinematic study to report a link between broiler gait parameters and defined lameness scores. A commercial motion-capturing system recorded three-dimensional temporospatial information during walking. The hypothesis was that the gait characteristics of non-lame broilers (n = 10) would be intermediate to those of lame broilers (n = 12) and jungle fowl (n = 10, tested at two ages: immature and adult). Data analysed using multi-level models, to define an extensive range of baseline gait parameters, revealed inter-group similarities and differences. Natural selection is likely to have made jungle fowl walking gait highly efficient. Modern broiler chickens possess an unbalanced body conformation due to intense genetic selection for additional breast muscle (pectoral hypertrophy) and whole body mass. Together with rapid growth, this promotes compensatory gait adaptations to minimise energy expenditure and triggers high lameness prevalence within commercial flocks; lameness creating further disruption to the gait cycle and being an important welfare issue. Clear differences were observed between the two lines (short stance phase, little double-support, low leg lift, and little back displacement in adult jungle fowl; much double-support, high leg lift, and substantial vertical back movement in sound broilers) presumably related to mass and body conformation. Similarities included stride length and duration. Additional modifications were also identified in lame broilers (short stride length and duration, substantial lateral back movement, reduced velocity) presumably linked to musculo-skeletal abnormalities. Reduced walking velocity suggests an attempt to minimise skeletal stress and/or discomfort, while a shorter stride length and time, together with longer stance and double-support phases, are associated with instability. We envisage a key future role for this highly quantitative methodology in pain assessment (associated with broiler lameness) including experimental examination of therapeutic agent efficacy.     

Biomechanics of the double rocker sole shoe: gait kinematics and kinetics

The use of footwear with contoured soles is common in treatment and care of patients with diabetes; these rocker sole shoes are designed to alleviate loading in key areas on the plantar surface of the foot, reducing pressure in key areas and alleviating pain, and potential soft tissue damage. While investigations of pressure changes have been conducted, no quantitative study to date has addressed the three-dimensional (3D) kinematic and kinetic changes that result from using these shoes. Forty subjects were tested wearing both unmodified and double rocker sole shoes, and the resulting motion patterns were compared to assess change caused by the rocker sole. Overall walking speed remained unchanged throughout testing; slightly increased flexion (<5 degrees ) was apparent at the hip, knee, and ankle during early and mid-stance. These results demonstrate the maintenance of gait function with minimal kinematic changes when using the rocker sole shoe. Investigations of multisegmental foot motion may reveal additional information about the contour effects; analysis of contour variations may also be warranted to investigate the possibility of controlling motion based on rocker sole parameters.     

Estimation of muscle forces in gait using a simulation of the electromyographic activity and numerical optimization

Clinical gait analysis provides great contributions to the understanding of gait patterns. However, a complete distribution of muscle forces throughout the gait cycle is a current challenge for many researchers. Two techniques are often used to estimate muscle forces: inverse dynamics with static optimization and computer muscle control that uses forward dynamics to minimize tracking. The first method often involves limitations due to changing muscle dynamics and possible signal artefacts that depend on day-to-day variation in the position of electromyographic (EMG) electrodes. Nevertheless, in clinical gait analysis, the method of inverse dynamics is a fundamental and commonly used computational procedure to calculate the force and torque reactions at various body joints. Our aim was to develop a generic musculoskeletal model that could be able to be applied in the clinical setting. The musculoskeletal model of the lower limb presents a simulation for the EMG data to address the common limitations of these techniques. This model presents a new point of view from the inverse dynamics used on clinical gait analysis, including the EMG information, and shows a similar performance to another model available in the OpenSim software. The main problem of these methods to achieve a correct muscle coordination is the lack of complete EMG data for all muscles modelled. We present a technique that simulates the EMG activity and presents a good correlation with the muscle forces throughout the gait cycle. Also, this method showed great similarities whit the real EMG data recorded from the subjects doing the same movement.     

The impact of centre of pressure error on predicted joint kinetics during cerebral palsy and typically developed gait: A clinical perspective

Centre of Pressure (CoP) location error is common when using kinematic and kinetic data to predict intersegmental forces and net joint moments during gait. Changes in peak moments due to CoP error have been reported in the literature. However, debate exists as to what levels of error are acceptable. The aim of this study was to examine the impact of CoP error on the kinetic profiles of children with typical development (TD) and children with cerebral palsy (CP) during gait. Three-dimensional kinematic and kinetic data were recorded and simulated CoP errors were applied at 3 mm, 6 mm, 9 mm, 12 mm increments in both positive and negative anteroposterior and mediolateral directions. Absolute differences in maximum kinetic parameters between increments were assessed in conjunction with changes in the Gait Deviation Index-Kinetic (GDI-Kinetic). Changes in GDI-Kinetic above 3.6 points were considered clinically significant. Maximum peak changes of up to 24.8% (CP) and 34.7% (TD) (sagittal plane) and up to 36.8% (CP) and 61.5% (TD) (coronal plane) were demonstrated at the knee. While absolute percentage differences were high at some error increments, GDI-Kinetic results suggested that such large percentage differences may still be clinically acceptable. Children with TD demonstrated clinically significant changes in GDI-Kinetic for CoP displacements of 9 mm and 12 mm, corresponding to 23% and 35% absolute differences in maximum moments. In contrast, the clinically significant threshold was not reached for children with CP that may be related to a slower walking speed. The findings of this study highlight the need for laboratories to consider the thresholds currently used for CoP error, which will help guide quality assurance procedures.     

Changes in electromyographic activity after botulinum toxin injection of the rectus femoris in patients with hemiparesis walking with a stiff-knee gait

PurposeThis study was designed to evaluate the effects of botulinum toxin type-A (BoNTA) injection of the rectus femoris (RF) muscle on the electromyographic activity of the knee flexor and extensor and on knee and hip kinematics during gait in patients with hemiparesis exhibiting a stiff-knee gait.MethodTwo gait analyses were performed on fourteen patients: before and four weeks after BoNTA injection. Spatiotemporal, kinematic and electromyographic parameters were quantified for the paretic limb.ResultsBoNTA treatment improved gait velocity, stride length and cadence with an increase of knee angular velocity at toe-off and maximal knee flexion in the swing phase. Amplitude and activation time of the RF and co-activation duration between the RF and biceps femoris were significantly decreased. The instantaneous mean frequency of RF was predominantly lower in the pre-swing phase.ConclusionsThe results clearly show that BoNTA modified the EMG amplitude and frequency of the injected muscle (RF) but not of the synergist and antagonist muscles. The reduction in RF activation frequency could be related to increased activity of slow fibers. The frequency analysis of EMG signals during gait appears to be a relevant method for the evaluation of the effects of BoNTA in the injected muscle.     

Effects of Quadriceps Muscle Fatigue on Stiff-Knee Gait in Patients with Hemiparesis

The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients.     

Clinical telemetry of EMG and temporal information during gait.

Multichannel telemetry has formed an integral part of the clinical assessment of children's walking problems. EMG signals and temporal information from foot switches are transmitted from a small belt-pack unit which provides almost complete freedom of movement for the child. Although patients with various crippling diseases have been studied, the investigation of problems resulting from cerebral palsy has been most valuable clinically. The effects of orthopaedic surgery to release or transfer muscles can be asssessed more positively and the causes of some unexplained gait patterns can be investigated more thoroughly.     

Genetic analysis of kinematic traits at the trot in Lusitano horse subpopulations with different types of training

The possibility of using quantitative kinematic traits as indirect selection criteria for sport performance could be beneficial to perform an early genetic evaluation of the animals. The genetic parameters for objectively measured kinematic traits under field conditions have been estimated for the first time, in order to potentially use these traits as indicators of gait quality in future selection of the Lusitano breed. The repeatability within three different types of training (dressage, bullfighting and untrained) was also discussed. A total of 176 males (4 to 14 years old) were recorded at trot in hand using a 3D videographic system. The speed and 10 kinematic traits were studied (one temporal, two linear and seven angular variables). The genetic parameters of the kinematic variables were estimated using VCE software. The heritability estimates were moderate to high (0.18 to 0.53). The stride length and the forelimb angular variables presented the highest heritabilities (0.49 to 0.53), whereas the hindlimb angular variables revealed the lowest values (0.18 to 0.40). More than half of the genetic correlations were moderately to highly positive (mostly 0.20 to 0.70; up to 0.88 between hindlimb traits). The dressage and bullfighting groups presented the highest repeatabilities (over 0.6) in the majority of the traits, maybe because of the acquired gait regularity expected in animals subjected to specific training, and suggesting a greater influence of the individuals over the kinematic traits studied in these two subpopulations than in the untrained subpopulation. The longer swing phase duration and the larger range of motion of the elbow, hock and pelvis joints observed in the dressage group may indicate a better gait quality of this group, according to FEI (International Equestrian Federation) standards. The bullfighting and untrained groups were more similar to each other in terms of kinematic traits. Selection of young horses for characteristics such as stride length and the hindlimbs traits can apparently contribute to further genetic improvement of the performance of Lusitano breed.     

A musculoskeletal foot model for clinical gait analysis

Several full body musculoskeletal models have been developed for research applications and these models may potentially be developed into useful clinical tools to assess gait pathologies. Existing full-body musculoskeletal models treat the foot as a single segment and ignore the motions of the intrinsic joints of the foot. This assumption limits the use of such models in clinical cases with significant foot deformities. Therefore, a three-segment musculoskeletal model of the foot was developed to match the segmentation of a recently developed multi-segment kinematic foot model. All the muscles and ligaments of the foot spanning the modeled joints were included. Muscle pathways were adjusted with an optimization routine to minimize the difference between the muscle flexion–extension moment arms from the model and moment arms reported in literature. The model was driven by walking data from five normal pediatric subjects (aged 10.6±1.57 years) and muscle forces and activation levels required to produce joint motions were calculated using an inverse dynamic analysis approach. Due to the close proximity of markers on the foot, small marker placement error during motion data collection may lead to significant differences in musculoskeletal model outcomes. Therefore, an optimization routine was developed to enforce joint constraints, optimally scale each segment length and adjust marker positions. To evaluate the model outcomes, the muscle activation patterns during walking were compared with electromyography (EMG) activation patterns reported in the literature. Model-generated muscle activation patterns were observed to be similar to the EMG activation patterns.