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Predicting Gait Patterns of Children With Spasticity by Simulating Hyperreflexia
Kirsten Veerkamp1,2,3,4,5, Christopher P Carty3,4,5,6, Niels F J Waterval1,2,7
1Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands.
Insights
Velocity-based hyperreflexia in specific muscles explains distinct spastic gait patterns in children. This finding aids in developing targeted treatments for pediatric neuromusculoskeletal disorders and improving gait deviations.
Area of Science:
- Biomedical Engineering
- Neurology
- Pediatrics
Background:
- Spasticity is a frequent impairment in pediatric neuromusculoskeletal disorders, significantly impacting gait.
- Understanding the mechanisms of spasticity-induced gait deviations is crucial for effective treatment selection.
Purpose of the Study:
- To investigate the pathophysiological mechanisms behind gait deviations in children with spasticity.
- To utilize predictive simulations to model and understand spastic gait patterns.
Main Methods:
- Cluster analysis of experimental gait data from 17 children with spasticity to identify distinct gait patterns.
- Forward dynamic simulation using a generic musculoskeletal model with velocity- or force-based hyperreflexia.
- Optimization of hyperreflexia parameters to match simulated gait with experimental patterns.
Main Results:
- Three distinct spastic gait patterns were identified: increased knee flexion, increased ankle plantar flexion, and combined increased knee and ankle flexion.
- Velocity-based hyperreflexia models more accurately predicted experimental gait patterns than force-based models.
- Specific muscle hyperreflexia (e.g., rectus femoris, hamstrings, gastrocnemius, soleus) were linked to distinct gait deviations.
Conclusions:
- Velocity-based hyperreflexia in specific muscles is a key contributor to different spastic gait patterns in children.
- These findings provide a mechanistic basis for understanding spastic gait.
- The results support the development of targeted therapeutic interventions for pediatric spasticity.
Abstract:
Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was performed to extract distinct gait patterns from experimental gait data of 17 children with spasticity to be used as comparative validation data. A forward dynamic simulation framework was employed to predict gait with either velocity- or force-based hyperreflexia. This framework entailed a generic musculoskeletal model controlled by reflexes and supraspinal drive, governed by a multiobjective cost function. Hyperreflexia values were optimized to enable the simulated gait to best match experimental gait patterns. Three experimental gait patterns were extracted: (1) increased knee flexion, (2) increased ankle plantar flexion, and (3) increased knee flexion and ankle plantar flexion when compared with typical gait. Overall, velocity-based hyperreflexia outperformed force-based hyperreflexia. The first gait pattern could mostly be explained by rectus femoris and hamstrings velocity-based hyperreflexia, the second by gastrocnemius velocity-based hyperreflexia, and the third by gastrocnemius, soleus, and hamstrings velocity-based hyperreflexia. This study shows how velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, which may help in providing targeted treatment.
