Crouched posture maximizes ground reaction forces generated by muscles.

Crouch gait decreases walking efficiency due to the increased knee and hip flexion during the stance phase of gait. Crouch gait is generally considered to be disadvantageous for children with cerebral palsy; however, a crouched posture may allow biomechanical advantages that lead some children to adopt a crouch gait. To investigate one possible advantage of crouch gait, a musculoskeletal model created in OpenSim was placed in 15 different postures from upright to severe crouch during initial, middle, and final stance of the gait cycle for a total of 45 different postures. A series of optimizations was performed for each posture to maximize transverse plane ground reaction forces in the eight compass directions by modifying muscle forces acting on the model. We compared the force profile areas across all postures. Larger force profile areas were allowed by postures from mild crouch (for initial stance) to crouch (for final stance). The overall ability to generate larger ground reaction force profiles represents a mechanical advantage of a crouched posture. This increase in muscle capacity while in a crouched posture may allow a patient to generate new movements to compensate for impairments associated with cerebral palsy, such as motor control deficits.

[1]  D. Kerrigan,et al.  Kinetics of stiff-legged gait: induced acceleration analysis. , 1999, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[2]  M. Pandy,et al.  Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait. , 2005, Journal of biomechanics.

[3]  G T Rab,et al.  Hamstrings in Cerebral Palsy Crouch Gait , 1993, Journal of pediatric orthopedics.

[4]  J G Gamble,et al.  Energy Cost of Walking in Normal Children and in Those with Cerebral Palsy: Comparison of Heart Rate and Oxygen Uptake , 1989, Journal of pediatric orthopedics.

[5]  Ajay Seth,et al.  Muscle contributions to propulsion and support during running. , 2010, Journal of biomechanics.

[6]  H J Sommer,et al.  A three-dimensional musculoskeletal database for the lower extremities. , 1997, Journal of biomechanics.

[7]  S. Delp,et al.  Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait. , 2008, Journal of biomechanics.

[8]  M Gough,et al.  Lower limb extensor moments in children with spastic diplegic cerebral palsy. , 2004, Gait & posture.

[9]  J. Rose,et al.  ENERGY EXPENDITURE INDEX OF WALKING FOR NORMAL CHILDREN AND FOR CHILDREN WITH CEREBRAL PALSY , 1990, Developmental medicine and child neurology.

[10]  S. Delp,et al.  The effect of excessive tibial torsion on the capacity of muscles to extend the hip and knee during single-limb stance. , 2007, Gait & posture.

[11]  T. Wren,et al.  Prevalence of Specific Gait Abnormalities in Children With Cerebral Palsy: Influence of Cerebral Palsy Subtype, Age, and Previous Surgery , 2005, Journal of pediatric orthopedics.

[12]  Jack R Engsberg,et al.  Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. , 2007, Archives of physical medicine and rehabilitation.

[13]  Ayman Habib,et al.  OpenSim: Open-Source Software to Create and Analyze Dynamic Simulations of Movement , 2007, IEEE Transactions on Biomedical Engineering.

[14]  May Q. Liu,et al.  The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait. , 2006, Gait & posture.

[15]  M. Pandy,et al.  Individual muscle contributions to support in normal walking. , 2003, Gait & posture.

[16]  Joyce P Trost,et al.  Examination of the child with cerebral palsy. , 2010, The Orthopedic clinics of North America.

[17]  Amanda Honeycutt,et al.  Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment--United States, 2003. , 2004, MMWR. Morbidity and mortality weekly report.

[18]  Jon R. Davids,et al.  The Treatment of Gait Problems in Cerebral Palsy , 2005 .

[19]  D. Paley Dynamic Deformities and Lever Arm Considerations , 2002 .

[20]  F. Zajac Muscle and tendon: properties, models, scaling, and application to biomechanics and motor control. , 1989, Critical reviews in biomedical engineering.

[21]  Michael H Schwartz,et al.  A baseline of dynamic muscle function during gait. , 2006, Gait & posture.

[22]  J. Stanghelle,et al.  Musculoskeletal pain in adults with cerebral palsy compared with the general population. , 2004, Journal of rehabilitation medicine.

[23]  M G Pandy,et al.  Static and dynamic optimization solutions for gait are practically equivalent. , 2001, Journal of biomechanics.

[24]  Sylvia Ounpuu,et al.  Natural Progression of Gait in Children With Cerebral Palsy , 2002, Journal of pediatric orthopedics.