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

Neuro-musculoskeletal modelling can provide insight into the aberrant muscle function during walking in those suffering cerebral palsy (CP). However, such modelling employs optimization to estimate muscle activation that may not account for disturbed motor control and muscle weakness in CP. This study evaluated different forms of neuro-musculoskeletal model personalization and optimization to estimate musculotendon forces during gait of nine children with CP (GMFCS I-II)and nine typically developing (TD)children. Data collection included 3D-kinematics, ground reaction forces, and electromyography (EMG)of eight lower limb muscles. Four different optimization methods estimated muscle activation and musculotendon forces of a scaled-generic musculoskeletal model for each child walking, i.e. (i)static optimization that minimized summed-excitation squared; (ii)static optimization with maximum isometric muscle forces scaled to body mass; (iii)an EMG-assisted approach using optimization to minimize summed-excitation squared while reducing tracking errors of experimental EMG-linear envelopes and joint moments; and (iv)EMG-assisted with musculotendon model parameters first personalized by calibration. Both static optimization approaches showed a relatively low model performance compared to EMG envelopes. EMG-assisted approaches performed much better, especially in CP, with only a minor mismatch in joint moments. Calibration did not affect model performance significantly, however it did affect musculotendon forces, especially in CP. A model more consistent with experimental measures is more likely to yield more physiologically representative results. Therefore, this study highlights the importance of calibrated EMG-assisted modelling when estimating musculotendon forces in TD children and even more so in children with CP.@en