The goals of this study were to determine if the muscle contributions to vertical and fore-aft acceleration of the mass center differ between crouch gait and unimpaired gait and if these muscle contributions change with crouch severity. Examining muscle contributions to mass center acceleration provides insight into the roles of individual muscles during gait and can provide guidance for treatment planning. We calculated vertical and fore-aft accelerations using musculoskeletal simulations of typically developing children and children with cerebral palsy and crouch gait. Analysis of these simulations revealed that during unimpaired gait the quadriceps produce large upward and backward accelerations during early stance, whereas the ankle plantarflexors produce large upward and forward accelerations later in stance. In contrast, during crouch gait, the quadriceps and ankle plantarflexors produce large, opposing fore-aft accelerations throughout stance. The quadriceps force required to accelerate the mass center upward was significantly larger in crouch gait than in unimpaired gait and increased with crouch severity. The gluteus medius accelerated the mass center upward during midstance in unimpaired gait; however, during crouch gait the upward acceleration produced by the gluteus medius was significantly reduced. During unimpaired gait the quadriceps and ankle plantarflexors accelerate the mass center at different times, efficiently modulating fore-aft accelerations. However, during crouch gait, the quadriceps and ankle plantarflexors produce fore-aft accelerations at the same time and the opposing fore-aft accelerations generated by these muscles contribute to the inefficiency of crouch gait.

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Impaired control of mediolateral body motion during walking is an important health concern. Developing treatments to improve mediolateral control is challenging, partly because the mechanisms by which muscles modulate mediolateral ground reaction force (and thereby modulate mediolateral acceleration of the body mass center) during unimpaired walking are poorly understood. To investigate this, we examined mediolateral ground reaction forces in eight unimpaired subjects walking at four speeds and determined the contributions of muscles, gravity, and velocity-related forces to the mediolateral ground reaction force by analyzing muscle-driven simulations of these subjects. During early stance (0-6% gait cycle), peak ground reaction force on the leading foot was directed laterally and increased significantly (p<0.05) with walking speed. During early single support (14-30% gait cycle), peak ground reaction force on the stance foot was directed medially and increased significantly (p<0.01) with speed. Muscles accounted for more than 92% of the mediolateral ground reaction force over all walking speeds, whereas gravity and velocity-related forces made relatively small contributions. Muscles coordinate mediolateral acceleration via an interplay between the medial ground reaction force contributed by the abductors and the lateral ground reaction forces contributed by the knee extensors, plantarflexors, and adductors. Our findings show how muscles that contribute to forward progression and body-weight support also modulate mediolateral acceleration of the body mass center while weight is transferred from one leg to another during double support.

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Pathological movement patterns like crouch gait are characterized by abnormal kinematics and muscle activations that alter how muscles support the body weight during walking. Individual muscles are often the target of interventions to improve crouch gait, yet the roles of individual muscles during crouch gait remain unknown. The goal of this study was to examine how muscles contribute to mass center accelerations and joint angular accelerations during single-limb stance in crouch gait, and compare these contributions to unimpaired gait. Subject-specific dynamic simulations were created for ten children who walked in a mild crouch gait and had no previous surgeries. The simulations were analyzed to determine the acceleration of the mass center and angular accelerations of the hip, knee, and ankle generated by individual muscles. The results of this analysis indicate that children walking in crouch gait have less passive skeletal support of body weight and utilize substantially higher muscle forces to walk than unimpaired individuals. Crouch gait relies on the same muscles as unimpaired gait to accelerate the mass center upward, including the soleus, vasti, gastrocnemius, gluteus medius, rectus femoris, and gluteus maximus. However, during crouch gait, these muscles are active throughout single-limb stance, in contrast to the modulation of muscle forces seen during single-limb stance in an unimpaired gait. Subjects walking in crouch gait rely more on proximal muscles, including the gluteus medius and hamstrings, to accelerate the mass center forward during single-limb stance than subjects with an unimpaired gait.@en