The influence of maximum isometric muscle force scaling on estimated muscle forces from musculoskeletal models of children with cerebral palsy.

BACKGROUND Musculoskeletal models do not include patient-specific muscle forces but rely on a scaled generic model, with muscle forces left unscaled in most cases. However, to use musculoskeletal simulations to inform clinical decision-making in children with cerebral palsy (CP), inclusion of subject-specific muscle forces is of utmost importance in order to represent each child's compensation mechanisms introduced through muscle weakness. RESEARCH AIM The aims of this study were to (i) evaluate if maximum isometric muscle forces (MIMF) in musculoskeletal models of children with CP can be scaled based on strength measurements obtained with a hand-held-dynamometer (HHD), (ii) evaluate the impact of the HHD based scaling approach and previously published MIMF scaling methods on computed muscle forces during gait, and (iii) compare maximum muscle forces during gait between CP and typically developing (TD) children. METHODS Strength and motion capture data of six CP and motion capture data of six TD children were collected. The HHD measurements to obtain hip, knee and ankle muscle strength were simulated in OpenSim and used to modify MIMF of the 2392-OpenSim model. These muscle forces were compared to the MIMF scaled on the child's body mass and a scaling approach, which included the body mass and muscle-tendon lengths. OpenSim was used to calculate peak muscle forces during gait. RESULTS Ankle muscle strength was insufficient to reproduce joint moments during walking when MIMF were scaled based on HHD. During gait, peak hip and knee extensor muscle forces were higher and peak ankle dorsi-flexor forces were lower in CP compared to TD participants. SIGNIFICANCE HHD measurements can be used to scale MIMF for the hip and knee muscle groups but underestimate the force capacity of the ankle muscle groups during walking. Muscle-tendon-length and mass based scaling methods affected muscle activations but had little influence on peak muscle forces during gait.