Computer modeling of gait abnormalities in cerebral palsy: application to treatment planning

The treatment of gait abnormalities in persons with cerebral palsy is challenging. Theoretically, gait abnormalities can be diminished by decreasing the muscle forces that disrupt normal movement (e.g. via muscle–tendon lengthenings or tone-altering medications) and/or increasing the muscle and ground reaction forces that have the potential to improve movement (e.g. via strengthening exercises, orthoses, or derotational osteotomies). However, different patients exhibit varying degrees of neurologic impairment, spasticity, weakness, and bone deformity, suggesting that gait deviations arise from a variety of sources, each of which requires a different treatment. Treatment planning is further complicated because there is currently no scientific basis for determining how patients’ neuromusculoskeletal impairments contribute to abnormal movement. This paper describes how biomechanical models can be used, in combination with experimental data, to enhance our understanding of gait abnormalities and to provide a theoretical basis for planning treatments. Two examples are presented, and suggestions for future work are discussed.