Computational modelling of the neuromusculoskeletal system (NMSS) can potentially provide detailed insight into muscle function to optimize treatment planning and evaluation in cerebral palsy (CP). Commonly, static optimization is used to solve the redundancy problem in estimating muscle forces, assuming, for example, minimization of the muscle activation squared. However, since the primary problem in children with CP is an aberrant motor control [1], it is questionable if using this criterion is applicable in this clinical population. Electromyography (EMG) might be used to further inform optimization procedures and improve model performance.@en

Accurate predictive simulations of human gait rely on optimisation criteria to solve the system's redundancy. Defining such criteria is challenging, as the objectives driving the optimization of human gait are unclear. This study evaluated how minimising various physiologically-based criteria (i.e., cost of transport, muscle activity, head stability, foot–ground impact, and knee ligament use) affects the predicted gait, and developed and evaluated a combined, weighted cost function tuned to predict healthy gait. A generic planar musculoskeletal model with 18 Hill-type muscles was actuated using a reflex-based, parameterized controller. First, the criteria were applied into the base simulation framework separately. The gait pattern predicted by minimising each criterion was compared to experimental data of healthy gait using coefficients of determination (R2) and root mean square errors (RMSE) averaged over all biomechanical variables. Second, the optimal weighted combined cost function was created through stepwise addition of the criteria. Third, performance of the resulting combined cost function was evaluated by comparing the predicted gait to a simulation that was optimised solely to track experimental data. Optimising for each of the criteria separately showed their individual contribution to distinct aspects of gait (overall R2: 0.37–0.56; RMSE: 3.47–4.63 SD). An optimally weighted combined cost function provided improved overall agreement with experimental data (overall R2: 0.72; RMSE: 2.10 SD), and its performance was close to what is maximally achievable for the underlying simulation framework. This study showed how various optimisation criteria contribute to synthesising gait and that careful weighting of them is essential in predicting healthy gait.@en