Title: “I had a dream.... in 1993, 25 years ago."
In the presentation, I allude to the difficulties / uncertainties one encounters in treating children with CP, which are not only related to pure medical issues (e.g., expectations of parents, patient, change of policies with more focus on quality of life)
Guy Molenaers is a Professor and medical head of department orthopaedic surgery at UZ Leuven (Pellenberg). He is an orthopaedist and surgeon who leads the multidisciplinary rehabilitation centre at Pellenberg.
Marjolein van der Krogt
Title: Neuro-musculoskeletal modeling of gait in cerebral palsy: where we are and where to go
In this presentation, I will present our recent advances in developing CP-specific simulations, implementing pathological features including spasticity and contractures, muscle weakness, and bony morphology; as well as EMG-assisted simulations. Furthermore, I will present how we can implement these features in predictive, forward dynamic simulations of gait, in order to unravel how these impairments impact the gait in children with cerebral palsy.
Marjolein van der Krogt is Assistant Professor and head of the Laboratory for Clinical Movement Analysis at the Amsterdam UMC (location VUmc), Department of Rehabilitation Medicine. Marjolein graduated cum laude in 2004 as a Human Movement Scientist from the VU University in Amsterdam, and continued her PhD at the VU University Medical Center on Modeling of gait in children with CP. After her PhD, Marjolein performed postdoctoral projects at Stanford University, Gillette Children’s Specialty Healthcare, and the University of Twente. In her research, she strives towards a better understanding of movement deviations and their underlying impairments in children with neurological disorders, using musculoskeletal modeling and advanced gait analysis techniques, in order to reach better diagnostics and optimize treatment outcomes.
Title: Musculoskeletal modelling for clincial use - the Basel experience
Clinical interpretation of gait analysis data is guesswork if muscle activity and function are considered. The standard approach only produces net joint moments and joint power, which only indicate some possible general conclusions. EMG may help to verify such hypotheses, but it is only available from a limited number of muscles. Computational musculoskeletal modelling offers a way to gain more insight into possible muscle activity and function and, for decades, have been used in scientific studies. These scientific studies have produced very valuable results, independent of setting exact muscle parameters or anatomy. For this reason, we introduced musculoskeletal modelling five years ago as an addition to standard gait analysis in order to better understand an individual's gait pattern. I will talk about the modelling inputs for clinical use and decision making. Also, I will discuss clinical questions and how well they have been answered by the musculoskeletal modelling approach to date. It is evident that potential errors in musculoskeletal modelling need to be evaluated for clinical relevance.
Reinald Brunner is a professor at The University Children’s Hospital Basel. He is the Chief Physician of Neuro-Orthopedics and Research Group Leader of Human Locomotion Research. He currently serves as the Vice-dean of the medical faculty of The University Children’s Hospital Basel. He has served on the editorial board of the Journal of Pediatric Orthopedics and Prosthetics Orthotics International as well as being an associate editor for Gait & Posture. His research focuses on clinical outcome of treatment in the field of pediatric neuro-orthopaedics. This includes determination of a deformity for gait and its correction by orthotic or surgical treatment, as well as the evaluation of surgical or orthotic techniques in patient population such as cerebral palsy.
Title: From human movement to bone strains through MS modelling: is there a role with CP patients?
Subject-specific Finite Element (FE) models of bones from CT data are now able to predict strain levels in human bones with a good accuracy. In several studies, these models have been used to investigate bone status in different physiological but also pathological conditions. In all cases a key aspect is the identification of the boundary conditions, i.e. the loads that act on bones during human movement. This is generally pursued through musculoskeletal modelling strategies. Different approaches, characterised by various level of subject-specificity, can be adopted to reach the goal.
In my talk, I will illustrate some applications of musculoskeletal models we developed to estimate loading conditions of the skeleton in different pathological conditions, to be used as boundary conditions in finite element models of bones to evaluate the fracture risk. I hope to promote the discussion on possible application of similar approaches in CP subjects, considering that bone fragility is recognised to be an issue.
Fulvia Taddei is the director of the Bioengineering Computing Laboratory at Istituto Ortopedico Rizzoli in Bologna, Italy. She has a PhD in Biomedical Engineering from the University of Bologna (2004). She is member of the ESB since 2002 and member of the ASBMR since 2013. Her research interests include: the development of automatic methods for the generation of subject-specific finite element models of bone segments from diagnostic images for the in-vivo prediction of fracture risk; in-vivo muscles' forces prediction during various motor tasks and finite element modelling of bone from microCT data. She has published more than eighty papers on international journals. With a study on the safety factor of the human femur during daily activities she won the S. M. Perren Research Award of 2014 of the European Society of Biomechanics.
Ilse Jonkers is the head of the Human Movement Biomechanics Research Group at KU Leuven. She received her PhD in 2000 from KU Leuven. After postdoctoral stays at the University of Stanford and KU Leuven, she began her career as an independent researcher in 2009 with an appointment as an Assistant Professor at KU Leuven. The majority of her research activities rely on the use of 3D-motion analysis, personalized musculoskeletal modeling, and multi-body simulation. Using these methodologies, she wants to further the understanding of the neuromuscular constraints of gross motor function and relate gross motor function, joint and tissue loading to musculoskeletal adaptation. She hopes to provide fundamental insights to optimize rehabilitation strategies and surgical interventions. Her main expertise is in translating clinical questions into dedicated simulation and modeling approaches and the translation of their results back towards clinical treatment plans.
Title: Experimental measures to support patient-specific simulation in children with cerebral palsy
Kaat Desloovere is professor at the Department of Rehabilitation Sciences of K.U. Leuven and Service and Research Manager at the Clinical Motion Analysis Laboratory, at the University Hospital of Pellenberg (Leuven). Her research interest is in clinical motion analysis in different patient groups, with special focus on instrumented assessment of spasticity and muscle strength and on clinical decision making based on objective gait analysis, in children with cerebral palsy.
Friedl De Groote
Friedl De Groote is an assistant professor in the Human Movement Biomechanics Research Group at the Department of Movement Sciences, KU Leuven, Belgium. She received her MSc degree in Mechanical engineering and her PhD degree in Mechanical engineering from KU Leuven, in 2005 and 2009, respectively. From 2009 until 2016, she was a postdoctoral researcher at KU Leuven. She has been a visiting researcher at Stanford University, the University of Florida, and Georgia Tech/Emory University. She uses a blended computational and experimental approach to study the interaction between motor control and musculoskeletal dynamics in healthy and pathological movement. The key to this approach is the development of numerical methods for analysis and simulation of human motion and modeling of the neuro-musculoskeletal system. Her long-term aim is the development of predictive simulations of human motion that are sufficiently accurate and numerically efficient to be used for the design of training and treatment programs.
In 2005, Ann Hallemans obtained a PhD in Sciences studying the biomechanics of early walking. Currently, she is a research professor at the department of Rehabilitation Sciences and Physiotherapy and chairman of the M²OCEAN movement analysis lab at the Antwerp University Hospital. Her research focuses on neuromechanics and balance control in relation to childhood development.
Title: Subject-specific models of the lower extremity with applications in orthopaedics
In this talk I will present some recent technical development for generating subject-specific musculoskeletal models from medical images, and their applications to orthopaedic procedures, ranging from estimation of joint contact forces in total knee replacement to the simulation of the effect of high tibial osteotomies. The talk will consist of some preliminary results from my fellowship work and will outline the broader research plans in which they have to be considered.
Luca Modenese received a PhD in biomechanics in 2013 from Imperial College London and worked as postdoctoral researcher at the Centre for Musculoskeletal Research (Griffith University, Australia) and INSIGNEO Instituto for in silico Medicine (University of Sheffield, UK). In 2017, Luca was awarded an Imperial College Research Fellowship for a project focusing on using techniques from computational biomechanics to support pre-operative planning of orthopaedic procedures. His work focuses on generating and employing computational models for improving diagnosis and treatment of (neuro)musculoskeletal conditions such as cerebral palsy, juvenile idiopathic arthritis and knee osteoarthritis.
Title: Simulating the Effect of Surgical Interventions for Crouch Gait on Functional Knee Mechanics
Distal Femoral Extension Osteotomy (DFEO) and Patellar Tendon Advancement (PTA) surgeries are becoming increasingly common to treat persistent crouch gait. However, the effect of these surgeries on knee joint mechanics and the knee extensor mechanism remains poorly understood. My presentation will highlight a series of collaborative studies between the University of Wisconsin-Madison Neuromuscular Biomechanics Lab and Gillette Children’s Specialty Healthcare that applied a novel musculoskeletal simulation framework to gain insights into the effects of DFEO-PTA on knee mechanics during walking. First, it will address the coupled effects of crouch severity and patellar position on knee cartilage loading patterns. Subsequently, it will investigate whether biomechanical changes induced by DFEO-PTA, such as patellar tendon moment arms, are predictive of clinical outcomes.
Colin Smith is a Whitaker International postdoctoral fellow in the Laboratory for Movement Biomechanics at ETH Zurich. He received his MS (2016) and PhD (2017) in mechanical engineering from the University of Wisconsin-Madison. In 2016, he was an OpenSim Visiting Scholar at the National Center for Simulation in Rehabilitation Research (NCSRR) at Stanford University. His research focuses on the development and application of dynamic simulation and imaging techniques to improve treatments for musculoskeletal pathologies.
Title: The effect of EMG-constrained muscle force estimation on the outcome of botulinum toxin treatment in children with CP
Children with cerebral palsy (CP) present altered gait patterns and electromyography (EMG) activity compared to typically developing children. Considering the distinct EMG deviations in CP children, an EMG-constrained optimization approach, which accounts for the altered EMG activity, is often suggested when calculating muscle forces during gait. Botulinum Toxin type A (BTX-A) injections are used to correct the abnormal muscle balance in children with CP. In this presentation, I will show the effect of constraining calculated muscle activations by EMG signals (EMG-constrained optimization) on calculated muscle forces during gait and how it alters the conclusions on the effectiveness of BTX-A treatment in normalizing muscle force production.
Mariska Wesseling obtained her PhD in 2015 within the Human Movement Biomechanics Research Group at KU Leuven, mainly focusing on musculoskeletal modelling within a clinical context. After obtaining her PhD, she became a postdoctoral researcher at KU Leuven. Her research is currently focused on multiscale modelling, by linking musculoskeletal and finite element modelling, and the inclusion of subject-specific information within the modelling workflow.
Title: Predicting gait performance after orthopedic surgeries
Within the SimCP project, the Capability Gap is used to predict gait performance after orthopedic interventions. In this talk, I will show how the Capability Gap is calculate and how it can be used to compare the effect of different treatment options on the post-operative gait performance. I will present a case-study and highlight the advantages and disadvantages of the Capability Gap. After my talk, there will be a workshop in which participants can perform virtual surgery themselves and evaluate how the surgery would change the Capability Gap.
Hans Kainz is a research fellow at the KU Leuven (Belgium) exploring how subject-specific neuro-musculoskeletal models can be used to improve clinical-decision making in children with cerebral palsy. He obtained his PhD in biomechanics at Griffith University (Gold Coast, Australia) in November 2016 and previously worked as a clinical biomechanist at the Queensland Children’s Motion Analysis Service (Brisbane, Australia). He is a Marie Skłodowska-Curie fellow and his expertise is in gait analysis and subject-specific neuro-musculoskeletal modelling.
Sam Van Rossom
Title: Joint loading is normalized following single-event multilevel surgery but not following botulinum toxin injections in cerebral palsy patients
A pathological gait pattern is commonly present in patients with cerebral palsy (CP) and bony deformities are often attributed to the continuous presence of altered mechanical loading to the developing skeleton. Single-event multilevel orthopedic surgeries (SEMLS) or botulinum toxin injections (BTI) are frequently used to treat CP-patients aiming to reduce spasticity, normalizing the gait pattern and, as a result, musculoskeletal loading. I will show you the results of a retrospective study in which we compared musculoskeletal loading before and after a multilevel botox intervention or a single event multilevel surgery in 93 patients with diplegic CP patients.
Sam Van Rossom obtained his PhD in 2017 within the human movement biomechanics research group at KU Leuven. During his PhD, Sam investigated the relation between knee joint motion and loading and cartilage structure and MRI-based matrix composition. After his PhD, Sam became a postdoctoral researcher at KU Leuven and his current research is focusing on quantifying musculoskeletal loading during therapeutic exercises as well as in an industrial context in order to optimize work situations to reduce musculoskeletal disorders.
Antoine Falisse is a Ph.D. candidate in the Department of Movement Sciences at KU Leuven. He received a B.S. degree in Engineering Science (2012) and a M.S. degree in Biomedical Engineering (2014) from UC Louvain. In 2017, he was an OpenSim visiting scholar at the National Center for Simulation in Rehabilitation Research (NCSRR) at Stanford University. In 2017-2018, he was a visiting student in the Robotics Institute at Carnegie Mellon University. His research involves using musculoskeletal modeling and dynamic simulations to explore the interactions between mechanics and motor control in children with cerebral palsy.
Lorenzo Pitto is a PhD candidate in the Department of Movement Sciences at KU Leuven. He received both his B.S and M.S degrees in biomedical engineering from the University of Genova, Italy. From 2011 to 2016 he worked at the Orthopedic Institute Rizzoli, Bologna, Italy in the Bioengineering Computing Laboratory. Within the SimCP project he is developing an interface to model orthopedic surgeries and eventually predict their functional outcome, also investigating the influence of lack of selective motor control on these predictions.
Hoa Hoang is a post-doctoral researcher at KU Leuven (Belgium). He obtained his PhD at Griffith University (Australia) in 2018. His research aims to better understand and improve treatment outcomes of neuro and musculoskeletal pathologies through the application of neuro-musculoskeletal modeling.