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Cerebral palsy (CP) and Duchenne muscular dystrophy (DMD) are neuromuscular disorders characterized by muscle weakness. Weakness in CP has neural and non-neural components, whereas in DMD, weakness can be considered as a predominantly non-neural problem. Despite the different underlying causes, weakness is a constraint for the central nervous system when controlling gait. CP demonstrates decreased complexity of motor control during gait from muscle synergy analysis, which is reflected by a higher total variance accounted for by one synergy (tVAF 1 ). However, it remains unclear if weakness directly contributes to higher tVAF 1  in CP, or whether altered tVAF 1  reflects mainly neural impairments. If muscle weakness directly contributes to higher tVAF 1 , then tVAF 1  should also be increased in DMD. To examine the etiology of increased tVAF 1 , muscle activity data of gluteus medius, rectus femoris, medial hamstrings, medial gastrocnemius, and tibialis anterior were measured at self-selected walking speed, and strength data from knee extensors, knee flexors, dorsiflexors and plantar flexors, were analyzed in 15 children with CP [median (IQR) age: 8.9 (2.2)], 15 boys with DMD [8.7 (3.1)], and 15 typical developing (TD) children [8.6 (2.7)]. We computed tVAF 1  from 10 concatenated steps with non-negative matrix factorization, and compared tVAF 1  between the three groups with a Mann-Whiney  U -test. Spearman's rank correlation coefficients were used to determine if weakness in specific muscle groups contributed to altered tVAF 1 . No significant differences in tVAF 1  were found between DMD [tVAF 1 : 0.60 (0.07)] and TD children [0.65 (0.07)], while tVAF 1  was significantly higher in CP [(0.74 (0.09)] than in the other groups (both  p  < 0.005). In CP, weakness in the plantar flexors was related to higher tVAF 1  ( r  = −0.72). In DMD, knee extensor weakness related to increased tVAF 1  ( r  = −0.50). These results suggest that the non-neural weakness in DMD had limited influence on complexity of motor control during gait and that the higher tVAF 1  in children with CP is mainly related to neural impairments caused by the brain lesion.

Non-neural Muscle Weakness Has Limited Influence on Complexity of Motor Control during Gait