Evaluation of a method to scale muscle strength for gait simulations of children with cerebral palsy |
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| Affiliation: | 1. Department of Mechanical Engineering, Colorado School of Mines, Golden, CO 80401, United States;2. Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198, United States;1. School of Mechanical and Aerospace Engineering, Queen’s University Belfast, Belfast, UK;2. Primary Joint Unit, Musgrave Park Hospital, Belfast, UK;3. School of Mechanical & Manufacturing Engineering, Dublin City University, Dublin, Ireland;4. Centre for Medical Engineering Research, School of Mechanical & Manufacturing Engineering, Dublin City University, Dublin, Ireland;5. Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland;6. Queen’s University Belfast, School of Pharmacy, Belfast, UK;1. KU Leuven, Department of Kinesiology, Human Movement Biomechanics, Heverlee, Belgium;2. KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium;3. Hip Unit, Orthopaedic Department, Ziekenhuis Oost-limburg, Genk, Belgium;4. UZ Pellenberg Orthopedic Department, University Hospitals Leuven, Pellenberg, Belgium;5. Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium;1. University of Bologna, Italy;2. ORLAU, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK;1. Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA;2. Bioengineering, Stanford University, Stanford, CA, USA;1. Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium;2. Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium;3. Department of Mechanical Engineering, KU Leuven, Leuven, Belgium;4. Department of Development and Regeneration, KU Leuven, Leuven, Belgium;5. Orthopaedic section University Hospitals Leuven, Belgium;6. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands;1. Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, The EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands;2. MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Van der Boechorststraat 9, 1081BT Amsterdam, The Netherlands;3. Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands |
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| Abstract: | Cerebral palsy (CP) is a neurological disorder that results in life-long mobility impairments. Musculoskeletal models used to investigate mobility deficits for children with CP often lack subject-specific characteristics such as altered muscle strength, despite a high prevalence of muscle weakness in this population. We hypothesized that incorporating subject-specific strength scaling within musculoskeletal models of children with CP would improve accuracy of muscle excitation predictions in walking simulations. Ten children (13.5 ± 3.3 years; GMFCS level II) with spastic CP participated in a gait analysis session where lower-limb kinematics, ground reaction forces, and bilateral electromyography (EMG) of five lower-limb muscles were collected. Isometric strength was measured for each child using handheld dynamometry. Three musculoskeletal models were generated for each child including a ‘Default’ model with the generic musculoskeletal model’s muscle strength, a ‘Uniform’ model with muscle strength scaled allometrically, and a ‘Custom’ model with muscle strength scaled based on handheld dynamometry strength measures. Muscle-driven gait simulations were generated using each model for each child. Simulation accuracy was evaluated by comparing predicted muscle excitations and measured EMG signals, both in the duration of muscle activity and the root-mean-square difference (RMSD) between signals. Improved agreement with EMG were found in both the ‘Custom’ and ‘Uniform’ models compared to the ‘Default’ model indicated by improvement in RMSD summed across all muscles, as well as RMSD and duration of activity for individual muscles. Incorporating strength scaling into musculoskeletal models can improve the accuracy of walking simulations for children with CP. |
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| Keywords: | Musculoskeletal modeling Biomechanics Pathological gait Muscle strength Strength scaling |
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