the number of muscles included in synergy analysis) impact these results. A secondary goal was to determine whether differences in clinical treatment or data collection protocols ( e.g. The aim of this research was to investigate whether walk-DMC is associated with treatment outcomes across clinical centers. Walk-DMC represents a summary measure of an individual’s synergy complexity. Since EMG data are collected as part of standard care in clinical gait analysis laboratories, synergy methods are attractive for quantifying patient-specific deficits in neuromuscular control. stroke and CP), even fewer synergies are required to describe the EMG data, suggesting a simplified control strategy that may contribute to impaired movement ( 12– 16). Synergy analysis uses EMG data and matrix factorization algorithms to identify a small set of weighted muscles groups (synergies) that are recruited together during functional tasks ( 9– 11). Walk-DMC leverages the theory of muscle synergies to create an objective measure of motor control that quantifies an individual’s complexity of neuromuscular control during walking ( 2, 8). Thus, it is important to determine whether differences between centers in procedures, outcomes, or collected data, refute or alter conclusions about whether walk-DMC is a useful measure to inform treatment planning. In clinical gait analyses, the number of muscles monitored with electromyography (EMG) varies between centers which may impact calculations of synergies and walk-DMC. For example, between centers, the dosage and number of muscles treated with botulinum toxin type A injection ( 5), amount of transection in selective dorsal rhizotomy ( 6), and choice of procedures in single-event multi-level orthopedic surgeries for children with CP ( 7) can a vary. Whether walk-DMC’s association with treatment outcomes extends across clinical centers remains an open question, especially considering differences in clinical protocols and treatments between centers. Reproducibility is critical to understand the generalizability and potential impact of new measures in the clinic, especially when considering that many published biomedical findings fail to be reproduced ( 4). Despite these initial promising results, the relationship between walk-DMC and treatment outcomes has only been evaluated at one center. These results support the common clinical belief that poor motor control can contribute to worse treatment outcomes. These studies also suggested that individuals with less impaired motor control, or higher walk-DMC scores, have greater improvements in walking ability after treatment than individuals with poor motor control. Recent research has suggested that measures derived from muscle synergy analysis, such as the Dynamic Motor Control Index during Walking (walk-DMC), may provide a clinical tool to quantify poor motor control and inform treatment planning ( 2, 3). Reduced motor control hinders movement and has been suggested as an important factor influencing treatment outcomes ( 1). Poor motor control often arises after neurologic injury, such as in cerebral palsy (CP).
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