S68 Oral Presentations / Gait & Posture 24S (2006) S7S97
pelvic tilt and ankle hyperdorsiflexion typically seen in true
crouch gait. It is noted that group D includes three of the four
patients without family history of HSP. Further analysis with
additional patients will further substantiate these patterns.
Acknowledgements
The authors would like to thank Dr. Michael Sussman,
Dr. Jonathan Sembrano, Rosemary Pierce, PT, Rita Davis,
PT and Susan Sienko Thomas, MA for their assistance.
References
[1] Fink JK. Arch Neurol 2003;60:10459.
[2] Klebe S, et al. J Neurol 2004;251:5718.
[3] Rodda JM, et al. JBJS (Br) 2004;86-B(2):2518.
doi:10.1016/j.gaitpost.2006.11.048
O-41
An exploration of the function of the triceps surae during
normal gait using functional electrical stimulation
Caroline Stewart a, , Neil Postans a , Michael Schwartz b,c ,
Adam Rozumalski b , Andrew Roberts a
a ORLAU, RJAH Orthopaedic Hospital, Oswestry, UK
b Gillette Childrens Specialty Healthcare, St. Paul, USA
c University of Minnesota, Minneapolis, MN, USA
1. Summary/conclusions
This study uses random bursts of functional electrical
stimulation (FES) to perturb normal gait. The results are used
as an indicator of the normal function of the calf muscles
and also to provide supporting evidence for predictions based
on induced acceleration analysis (IAA). Gastrocnemius and
soleus are shown to have opposing actions at the knee and
ankle during second rocker. These counterintuitive results
correlate with published predictions from IAA.
2. Introduction
The triceps surae muscle comprises soleus and the two
heads of gastrocnemius. All cross the ankle and subtalar
joints, having plantarflexing moment arms. Only gastrocne-
mius crosses the knee, where it has a flexing moment arm.
Manual muscle testing produces a predictable response and,
intuitively, the common tendon suggests a similar action at
the ankle.
Computer simulation techniques have been used to inves-
tigate the role of particular muscles during gait. Recent work
using IAA has yielded some surprising results for the calf
muscles, demonstrating that gastrocnemius and soleus some-
times have opposing functions [1,2]. IAA models, results,
presentation and interpretation vary and the approach is not
without its critics [3]. There is a clear need for additional
practical validation.
The aim of this study was to investigate the dynamic action
of the triceps surae muscles, during normal gait, using dis-
crete bursts of FES. IAA can also be considered to be a
perturbation away from the existing dynamics, hence the FES
results can be compared directly with IAA predictions.
3. Statement of clinical signicance
The triceps surae muscles are frequently implicated in
the development of pathological gait patterns in conditions
such as cerebral palsy. Many different treatments are recom-
mended, including surgery, Botulinum toxin injection and
stretching programmes. In order to treat the muscles appro-
priately it is important to understand their function during
normal walking.
Computer simulation is becoming a clinically important
tool in the decision making process following gait analysis.
If a direct link can be demonstrated between the response
of subjects in the gait laboratory and the results of the mod-
els then researchers and clinicians will have much greater
confidence in using this kind of information.
4. Methods
Five adult male subjects volunteered to take part in the
study. No subject had any pathology affecting their walking.
Each had one lower limb tested, selected at random. One pair
of FES electrodes was placed over the lateral head of the
gastrocnemius muscle and a second over soleus. The timing
of the stimulation was controlled using foot switches. The
pulse width of the stimulation was altered to elicit as strong
a contraction as was tolerable.
A full body marker set was used and gait data collected
using a Vicon 612 system in conjunction with a single Kistler
force plate. Six different stimulation conditions were tested,
the two muscles with three different timingsfirst, second
and third rockers. The order of the testing was randomized. In
each case a series of walking trials was collected, with each
trial randomly assigned for stimulation or no stimulation.
For the stimulation trials only the stance phase on the force
platform was stimulated. Data collection continued until at
least six good trials had been collected with and without the
stimulus.
The means of the stimulated and unstimulated trials were
compared. The difference showed the effect of the FES per-
turbation and was interpreted as the dynamic action of the
muscle. For example, where the stimulation caused greater
flexion the action was defined as flexing.
 Oral Presentations / Gait & Posture 24S (2006) S7S97
Fig. 1. Action of gastrocnemius and soleus during second rocker. A point is marked on the graph when the mean of five stimulated traces differed from the
mean of five interspersed unstimulated traces by at least 2 standard deviations.
5. Results
The results for the knee and ankle kinematics during sec-
ond rocker are shown (Fig. 1). This was the period in which
difference between the muscle actions was most prominent.
6. Discussion
The responses of individual subjects to the stimulation var-
ied, however a clear pattern emerges. During second rocker
gastrocnemius and soleus have antagonistic actions. The
action of gastrocnemius as an ankle dorsiexor and knee
flexor is certainly surprising. These results confirm predic-
tions from previous computer model simulations, in that they
highlight clear differences in action between two components
of the triceps surae [1,2]. The action at the knee is the same as
that reported by Neptune et al. [2]. The next step is to perform
subject-specific IAA simulations based on the data collected
and compare the effects of FES perturbations with the IAA
predictions in each case. It will be interesting to see whether
the IAA results confirm the patterns shown above and reflect
the same inter-subject variability.
References
[1] Hof AL, Otten E. Gait Posture 2005;22:1828.
S69
[2] Neptune RR, Kautz SA, Zajac FE. J Biomech 2001;34:138798.
[3] Chen G. Gait Posture 2006;23:3744.
doi:10.1016/j.gaitpost.2006.11.049
O-42
Dynamic simulations of slow, free, and fast walking: How
do muscles modulate forward progression?
May Liu a, , Ilse Jonkers b , Allison Arnold a , Michael
Schwartz c , Darryl Thelen d , Frank Anderson a , Scott Delp a
a Department of Mechanical Engineering & Bioengineering, Stanford
University, Stanford, USA
b Faculty of Kinesiology & Rehabilitation Sciences, KULeuven, Leuven,
Belgium
c Center for Gait & Motion Analysis, Gillette Childrens Specialty
Healthcare, St. Paul, USA
d Department of Mechanical Engineering, University of Wisconsin,
Madison, WI, USA
1. Summary/conclusions
Forward progression during walking is modulated by the
same muscles, regardless of speed. Propulsion from hip flex-
ors and plantarflexors increases with speed, as does the brak-
ing actions of knee extensors.