Simulated hemiparesis increases optimal spatiotemporal gait asymmetry but not metabolic cost

Several neuromuscular impairments, such as weakness (hemiparesis), occur after an individual has a stroke, and these impairments primarily affect one side of the body more than the other. Predictive musculoskeletal modeling presents an opportunity to investigate how a specific impairment affects gait performance post-stroke. Therefore, our aim was to use to predictive simulation to quantify the spatiotemporal asymmetries and changes to metabolic cost that emerge when muscle strength is unilaterally reduced. We also determined how forced spatiotemporal symmetry affects metabolic cost. We modified a 2-D musculoskeletal model by uniformly reducing the peak isometric muscle force in all left-limb muscles. We then solved optimal control simulations of walking across a range of speeds by minimizing the sum of the cubed muscle excitations across all muscles. Lastly, we ran additional optimizations to test if reducing spatiotemporal asymmetry would result in an increase in metabolic cost. Our results showed that the magnitude and direction of effort-optimal spatiotemporal asymmetries depends on both the gait speed and level of weakness. Also, the optimal metabolic cost of transport was 1.25 m/s for the symmetrical and 20% weakness models but slower (1.00 m/s) for the 40% and 60% weakness models, suggesting that hemiparesis can account for a portion of the slower gait speed seen in people post-stroke. Adding spatiotemporal asymmetry to the cost function resulted in small increases (~4%) in metabolic cost. Overall, our results indicate that spatiotemporal asymmetry may be optimal for people post-stroke, who have asymmetrical neuromuscular impairments. Additionally, the effect of speed and level of weakness on spatiotemporal asymmetry may explain the well-known heterogenous distribution of spatiotemporal asymmetries observed in the clinic. Future work could extend our results by testing the effects of other impairments on optimal gait strategies, and therefore build a more comprehensive understanding of the gait patterns in people post-stroke. Author Summary A stroke causes damage to the brain. This typically results in several changes to the nervous and muscular (neuromuscular) system that change how people post-stroke tend to walk and perform other tasks. Individuals post-stroke tend to walk with an asymmetrical motion and expend more energy while walking than other age-matched individuals. We still do not understand how each specific change to the neuromuscular system is linked with changes in walking patterns, in part because it is difficult to test one individual change at a time in people. Instead, we can use a mathematical model of the musculoskeletal system that represents the individual changes to the muscular system that occur in people post-stroke. In this study, we modeled how a common change in people post-stroke (muscle weakness) can impact walking patterns. We found that the level of weakness and the walking speed affect the asymmetrical walking patterns of our models, but do not change the total energy cost. Overall, our study is one step towards better understanding how neuromuscular changes in people post-stroke affects walking patterns. This knowledge could be applied to identify rehabilitation strategies that are most likely to improve walking in people post-stroke.