Understanding compensatory strategies for muscle weakness during gait by simulating activation deficits seen post-stroke

Musculoskeletal simulations have been used to explore compensatory strategies, but have focused on responses to simulated atrophy in a single muscle or muscle group. In a population such as stroke, however, impairments are seen in muscle activation across multiple muscle groups. The objective of this study was to identify available compensatory strategies for muscle weakness during gait by simulating activation deficits in multiple muscle groups. Three dimensional dynamics simulations were created from 10 healthy subjects (48.8 ± 13.3 years, self-selected speed 1.28 ± 0.17 m/s) and constraints were set on the activation capacity of the plantar flexor, dorsiflexor, and hamstrings muscle groups to simulate activation impairments seen post-stroke. When the muscle groups are impaired individually, the model requires that the plantar flexor, dorsiflexor, and hamstrings muscle groups are activated to at least 55%, 64%, and 18%, respectively, to recreate the subjects' normal gait pattern. The models were unable to recreate the normal gait pattern with simultaneous impairment of all three muscle groups. Other muscle groups are unable to assist the dorsiflexor muscles during early swing, which suggests that rehabilitation or assistive devices may be required to correct foot drop. By identifying how muscles can interact, clinicians may be able to develop specific strategies for using gait retraining and orthotic assistance to best address an individual's needs.

► Three dimensional dynamics simulations were created from 10 healthy subjects. ► Constraints were set on the activation capacity of muscle groups to simulate activation impairments seen post-stroke. ► Muscle groups are impaired individually using simulation techniques. ► To compensate for plantar flexor deficiency increases in the hamstrings and hip flexors were needed. ► Muscle groups are unable to assist the dorsiflexors during early swing.