A cerebral palsy assessment tool using anatomically based geometries and free-form deformation

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Abstract
A geometrical analysis tool for investigating muscle length change in cerebral palsy (CP) patients is presented. A subset of anatomically based geometries from the International Union of Physiological Sciences (IUPS) Physiome Project is used, which is derived from the visible human (VH) data set with muscle attachment information, and customised using volume-preserving free-form deformation (FFD), the ‘host-mesh’ technique. The model’s intended use is to provide pre- and post-surgery assessment for muscle lengthening, a surgery performed to help slacken tight muscles and improve gait. The model is illustrated using healthy patient data from motion capture as a validation followed by three CP case studies to highlight its use. The methodology is presented in three stages, (1) a FFD of the complete lower limb, (2) a focused geometric study on the semimembranosus (SM) and gastrocnemius (GT) muscles, and (3) an improved hybrid mechanics-FFD approach as an improvement for future analysis, with differentiation between muscle and tendon lengthening, and contact detection between sliding muscles. Finally, the issues, limitations, in particular with the marker system, and model improvements are discussed.