Stiff-knee gait is a troublesome movement disorder among children with cerebral palsy (CP), where peak swing phase knee flexion is diminished due to over-activity of the rectus femoris muscle. A common treatment for stiff-knee gait, rectus femoris transfer surgery, moves the muscle's distal tendon from the patella to the sartorius insertion on the tibia. As a biarticular muscle, rectus femoris may play a role in motor control and have unrecognized benefits for maintaining balance. We used musculoskeletal modeling, neuromuscular control, and forward dynamic simulation to investigate the role of rectus femoris tendon transfer surgery on balance recovery after support-surface perturbations for children with CP adopting two different crouched postures. We combined both high-level supraspinal and low-level spinal signals to generate 92 muscle excitations for tracking experimental whole body center of mass positions and velocities. Stability during balance recovery was evaluated by the minimum distance between the extrapolated center of mass and base of support boundary (b_min) and the minimum time to reach the boundary (TtB_min). The balance recovery of pre-surgical simulations (b_min=2.3+1.1cm, TtB_min=0.2+0.1s) were different (p=0.02), on average, than post-surgical simulations (b_min=-4.9+11.4cm, TtB_min=-0.1+0.3s) of rectus femoris transfers. The moderate crouch simulations (b_min=2.4+0.4cm, TtB_min=0.2+0.03s) were more stable than the mild crouch simulations (b_min=1.2+0.3cm, TtB_min=0.1+0.02s) following anterior translations of the support surface. These findings suggest that tendon transfer of rectus femoris affects balance recovery in children with CP.

Computer simulations are playing an increasingly important role in solving complex engineering problems, and have the potential to revolutionize experimentally-based medical decision making and treatment design. Experiments alone provide important but limited understanding of movement dynamics. Although we can measure some quantities, such as muscle activities and ground reaction forces, responsible for a movement, simulations complement these measurements with estimates of other important variables, such as muscle and joint forces. Simulations also allow us to establish cause-and-effect relationships giving insights into muscle function. Perhaps the most exciting feature of simulations is the potential to perform "what if" studies to test hypotheses, predict functional outcomes, and identify emergent behaviors. This paper highlights applications using OpenSim, including projects which: minimize measures of an unreasonable simulation; identify new movements as an athletic training tool to reduce injury risk, and establish relationships among posture, muscle forces, and ground reaction forces.

Movement science is driven by observation, but observation alone cannot elucidate principles of human and animal movement. Biomechanical modeling and computer simulation complement observations and inform experimental design. Biological models are complex and specialized software is required for building, validating, and studying them. Furthermore, common access is needed so that investigators can contribute models to a broader community and leverage past work. We are developing OpenSim, a freely available musculoskeletal modeling and simulation application and libraries specialized for these purposes, by providing: musculoskeletal modeling elements, such as biomechanical joints, muscle actuators, ligament forces, compliant contact, and controllers; and tools for fitting generic models to subject-specific data, performing inverse kinematics and forward dynamic simulations. OpenSim performs an array of physics-based analyses to delve into the behavior of musculoskeletal models by employing Simbody, an efficient and accurate multibody system dynamics code. Models are publicly available and are often reused for multiple investigations because they provide a rich set of behaviors that enables different lines of inquiry. This report will discuss one model developed to study walking and applied to gain deeper insights into muscle function in pathological gait and during running. We then illustrate how simulations can test fundamental hypotheses and focus the aims of in vivo experiments, with a postural stability platform and human model that provide a research environment for performing human posture experiments in silico. We encourage wide adoption of OpenSim for community exchange of biomechanical models and methods and welcome new contributors.