The goal of this work is to establish a scientific basis for treating crouch gait, one of the most common movement abnormalities among children with cerebral palsy. Crouch gait is characterized by persistent flexion of the knee. It is an inefficient means of locomotion;if not corrected it often leads to bone deformities and serious, life-long physical limitations. We will develop predictive tools to determine the probability that each of the common treatments for crouch gait will improve a subject's excess knee flexion. For each treatment, we will identify a set of predictive variables. We will then identify all subjects from a large database of patients who received the surgery and use these subjects'outcome data to choose a weighting coefficient for each of the biomechanics based predictive variables. We will assess the predictive accuracy when applied to a different set of subjects using cross validation. These tools will predict whether or not a particular surgery will improve a patient's excessive knee flexion. Our preliminary work suggests that 80% prediction accuracy is feasible The success of this project will result in rigorously tested methods to aid treatment planning for crouch gait, and will hopefully produce better, more predictable treatment outcomes. Although multi-joint movement abnormalities such as crouch gait are exceptionally complex, the development of statistical models that predict which patients will benefit from specific surgical treatments is an important and necessary step toward designing more effective treatments.

Public Health Relevance

The positive economic impact of this project is to maintain employment for the project participants. We have already lost one talented bioengineer, F.E. Anderson, because of the funding gap in this project arising from severe NIH paylines. Funding for this project will provide employment for Ajay Seth, Carolyn Mazenko, and Jennifer Hicks for the next two years.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
2R01HD033929-09A1
Application #
7735516
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Shinowara, Nancy
Project Start
1996-06-01
Project End
2011-08-31
Budget Start
2009-09-20
Budget End
2010-08-31
Support Year
9
Fiscal Year
2009
Total Cost
$390,557
Indirect Cost
Name
Stanford University
Department
Biomedical Engineering
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Seth, Ajay; Hicks, Jennifer L; Uchida, Thomas K et al. (2018) OpenSim: Simulating musculoskeletal dynamics and neuromuscular control to study human and animal movement. PLoS Comput Biol 14:e1006223
Hamner, Samuel R; Seth, Ajay; Steele, Katherine M et al. (2013) A rolling constraint reproduces ground reaction forces and moments in dynamic simulations of walking, running, and crouch gait. J Biomech 46:1772-6
Arnold, Edith M; Hamner, Samuel R; Seth, Ajay et al. (2013) How muscle fiber lengths and velocities affect muscle force generation as humans walk and run at different speeds. J Exp Biol 216:2150-60
Hamner, Samuel R; Delp, Scott L (2013) Muscle contributions to fore-aft and vertical body mass center accelerations over a range of running speeds. J Biomech 46:780-7
Steele, Katherine M; Seth, Ajay; Hicks, Jennifer L et al. (2013) Muscle contributions to vertical and fore-aft accelerations are altered in subjects with crouch gait. Gait Posture 38:86-91
John, Chand T; Anderson, Frank C; Higginson, Jill S et al. (2013) Stabilisation of walking by intrinsic muscle properties revealed in a three-dimensional muscle-driven simulation. Comput Methods Biomech Biomed Engin 16:451-62
Wang, Jack M; Hamner, Samuel R; Delp, Scott L et al. (2012) Optimizing Locomotion Controllers Using Biologically-Based Actuators and Objectives. ACM Trans Graph 31:
Draper, Christine E; Quon, Andrew; Fredericson, Michael et al. (2012) Comparison of MRI and ยน?F-NaF PET/CT in patients with patellofemoral pain. J Magn Reson Imaging 36:928-32
Steele, Katherine M; Demers, Matthew S; Schwartz, Michael H et al. (2012) Compressive tibiofemoral force during crouch gait. Gait Posture 35:556-60
John, Chand T; Seth, Ajay; Schwartz, Michael H et al. (2012) Contributions of muscles to mediolateral ground reaction force over a range of walking speeds. J Biomech 45:2438-43

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