Cerebral palsy, a severe motor disability among children, is a chronic neuromuscular disorder that affects an individual’s ability to control basic motor tasks, posture, and muscle coordination. Children diagnosed with cerebral palsy often have reduced walking ability compared to their typically developing peers, which limits their independence and overall quality of life. Despite early intervention to address anatomical and functional deficits for children with cerebral palsy, some children do not respond to treatment, in part, because the driving musculoskeletal sources of reduced mobility are challenging to identify separate from compensatory muscle action. For example, children with cerebral palsy often walk with a hip compensation strategy;​ however, how this strategy is related to the child’s self-selected walking speed remains unclear. In addition, tibial torsion, a common bone deformity seen in children with cerebral palsy, results in reduced capacity of lower limb muscles to support the body during gait. However, implications for compensatory gait strategies adopted by children with bone deformities have not yet been explored. Musculoskeletal modeling and simulation is a non-invasive tool used to evaluate muscle forces and functional roles during gait. These tools can be used to identify sources of altered walking patterns and evaluate current physical therapy and surgical procedures. However, the application of musculoskeletal models for children with cerebral palsy remains limited by model assumptions.

The purpose of this work was to provide a quantitative analysis of walking in children with cerebral palsy. Both joint and muscle level analyses were completed to evaluate how children with cerebral palsy walk, including how children walk at faster self-selected walking speeds and how children use compensatory gait patterns with lower limb bone deformities. Current assumptions limiting the accuracy and use of musculoskeletal modeling and simulation for children with cerebral palsy were addressed using sensitivity analyses and subject-specific model development. The results from this work provide novel information regarding gait mechanics in children with cerebral palsy and methods that have potential to guide therapy interventions.