Prediction of ground reaction forces and moments during walking in children with cerebral palsy

Julie Kloeckner; Rosa M S Visscher; William R Taylor; Elke Viehweger; Enrico De Pieri

doi:10.3389/fnhum.2023.1127613

Prediction of ground reaction forces and moments during walking in children with cerebral palsy

Front Hum Neurosci. 2023 Mar 8:17:1127613. doi: 10.3389/fnhum.2023.1127613. eCollection 2023.

Authors

Julie Kloeckner^{1

2}, Rosa M S Visscher^{1

3}, William R Taylor¹, Elke Viehweger^{3

4}, Enrico De Pieri^{3

4}

Affiliations

¹ Laboratory for Movement Biomechanics, Department of Health Science and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.
² Department of Biomedical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
³ Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
⁴ Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland.

Abstract

Introduction: Gait analysis is increasingly used to support clinical decision-making regarding diagnosis and treatment planning for movement disorders. As a key part of gait analysis, inverse dynamics can be applied to estimate internal loading conditions during movement, which is essential for understanding pathological gait patterns. The inverse dynamics calculation uses external kinetic information, normally collected using force plates. However, collection of external ground reaction forces (GRFs) and moments (GRMs) can be challenging, especially in subjects with movement disorders. In recent years, a musculoskeletal modeling-based approach has been developed to predict external kinetics from kinematic data, but its performance has not yet been evaluated for altered locomotor patterns such as toe-walking. Therefore, the goal of this study was to investigate how well this prediction method performs for gait in children with cerebral palsy.

Methods: The method was applied to 25 subjects with various forms of hemiplegic spastic locomotor patterns. Predicted GRFs and GRMs, in addition to associated joint kinetics derived using inverse dynamics, were statistically compared against those based on force plate measurements.

Results: The results showed that the performance of the predictive method was similar for the affected and unaffected limbs, with Pearson correlation coefficients between predicted and measured GRFs of 0.71-0.96, similar to those previously reported for healthy adults, despite the motor pathology and the inclusion of toes-walkers within our cohort. However, errors were amplified when calculating the resulting joint moments to an extent that could influence clinical interpretation.

Conclusion: To conclude, the musculoskeletal modeling-based approach for estimating external kinetics is promising for pathological gait, offering the possibility of estimating GRFs and GRMs without the need for force plate data. However, further development is needed before implementation within clinical settings becomes possible.

Keywords: cerebral palsy; gait analysis; ground reaction forces (GRFs); kinetics; musculoskeletal modeling.

Grants and funding

This study was partially financially supported by the Ralf Loddenkemper Foundation under grant CH-270.7.002.704-3. EDP was partially funded by the University of Basel Research Fund for Excellent Junior Researchers. The authors were grateful to the SNSF (32003B_200903) for supporting this investigation.