Comparison of Lower Limb Joint Reaction Forces in Patients with Cerebral Palsy and Typically Developing Individuals

TL;DR

This study compares joint reaction forces in children with cerebral palsy and typically developing children to better understand movement differences and improve treatment planning.

Contribution

The study provides a detailed comparison of lower limb joint reaction forces in CP and TD children using simulation-based methods.

Findings

Hip joint reaction forces in CP children were lower in anterior-posterior and vertical components compared to TD children.

Knee joint reaction forces in CP children were higher across all anatomical axes compared to TD children.

Ankle joint reaction forces showed mixed differences, with lower anterior-posterior but higher vertical forces in CP children.

Abstract

Background and Objectives: Kinematic and kinetic data from gait analysis are commonly used for clinical decision making in cerebral palsy (CP). However, these data may not fully capture the underlying causes of movement pathologies or effectively monitor post-treatment changes. Joint reaction forces (JRFs), estimated through simulation-based methods, provide valuable insights into the functional state of musculoskeletal components. Despite their importance, comprehensive evaluations of lower limb JRFs in CP are limited, and comparisons with typically developing (TD) individuals remain underexplored. This study aimed to provide a detailed comparison of lower limb JRFs between children with CP exhibiting mild crouch gait and age-matched TD children during self-selected walking speeds. Materials and Methods: Open-access gait datasets from eight children with CP and eight TD children were analyzed. A full-body musculoskeletal model was scaled to individual anthropometric data in OpenSim. Joint angles and moments were obtained using inverse kinematics and inverse dynamics, respectively. Ankle, knee, and hip JRFs were calculated using OpenSim’s Joint Reaction tool. Root-mean-square differences and Pearson correlation coefficients quantified the differences between CP and TD JRFs. Results: The anterior–posterior and vertical components of the hip JRFs in CP were lower than in TD children. CP knee JRFs exceeded TD values across all anatomical axes. For the ankle, the anterior–posterior JRF was lower in CP, whereas the vertical component was higher compared to TD. Conclusions: Children with CP experience distinct lower limb JRF patterns compared to TD children. While some findings align with previous studies, discrepancies in other components highlight the influence of model and patient-specific characteristics. These results emphasize the need for standardization in reporting patient data and systematic evaluations to improve the interpretation and applicability of JRF analyses in CP research and treatment planning.

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