Real-Time Musculoskeletal Surrogates for Pediatric Cerebral Palsy: a Credibility Pilot

Cerebral Palsy (CP) is a neurological disorder of movement and the most common cause of lifelong physical disability in childhood. Approximately 75% of children with CP are ambulatory, and accurate gait assessment is central to preserving walking function, which deteriorates by mid-adulthood in a quarter to half of adults with CP. The Rodda and Graham classification system quantifies sagittal-plane gait deviations using ankle and knee z-scores derived from 3D Instrumented Gait Analysis (3D-IGA), but 3D-IGA is expensive and limited to specialized centers, while observational assessment shows only moderate inter-rater agreement. We developed a markerless gait analysis pipeline that quantifies Rodda and Graham knee and ankle z-scores directly from single-view clinical gait videos. Across 1,058 bilateral limb samples from 529 trials of 152 children (88 male, 63 female; age 12.1 $\pm$ 4.0 years; 60 distinct primary diagnoses, cerebral palsy the most common at $n=54$), the sagittal-view model achieved $R^2 = 0.80 \pm 0.02$ and CCC $= 0.89 \pm 0.02$ for knee z-scores and $R^2 = 0.57 \pm 0.02$ and CCC $= 0.72 \pm 0.02$ for ankle z-scores against 3D-IGA. Binary screening for excess knee flexion achieves AUROC $= 0.88$, correctly identifying 83% of affected children, and applying Rodda and Graham rules yields $43 \pm 1$% 7-class accuracy with macro-AUROC $= 0.78 \pm 0.01$, ankle prediction error remaining the primary bottleneck. Beyond cross-sectional screening, continuous z-scores support longitudinal trajectory tracking across visits, providing a quantitative substrate for monitoring disease progression and treatment response unavailable from observational scales. These results demonstrate the feasibility of video-based z-score estimation, excess-flexion screening, and longitudinal trajectory tracking as a path toward scalable, objective gait assessment in low-resource clinical settings.

This paper investigates multi-degrees of freedom (DoF) joint kinematics estimation under partially observed surface electromyography (sEMG), where only a subset of task-relevant muscles can be measured due to anatomical inaccessibility or sensor constraints. A novel musculoskeletal neural network (MSK-NN) is proposed to estimate multi-DoF joint angles while simultaneously inferring activations for both measured and unmeasured muscles. MSK-NN consists of a CNN-based muscle activation estimator and an embedded MSK forward dynamics module, forming a fully differentiable architecture. Unlike existing hybrid neural frameworks that require additional biomechanical labels (e.g., muscle-tendon forces, joint torques), MSK-NN is trained without direct supervision of internal biomechanical variables. A composite physics-physiology loss is designed by incorporating a joint kinematics loss, a data-driven muscle synergy loss, and an anatomy-guided trend loss. The proposed method is evaluated on two-DoF wrist kinematics estimation across three rhythmic motions with unconstrained speed and amplitude, and one random motion. Compared with CNN, Bi-LSTM, CNN-LSTM, and PET baselines, MSK-NN achieves lower normalized root mean square error (NRMSE) and higher coefficient of determination (R2), especially for the random motion. More importantly, the optimized MSK parameters remain within physiological limits, and the estimated activation of an input-excluded muscle exhibits strong temporal agreement with its recorded sEMG envelope, demonstrating the capability of musculoskeletal (MSK)-NN to recover physiologically plausible activations.

Differentiable simulators have advanced policy learning and model-based control, yet actuator dynamics remain an important source of sim-to-real error. This is particularly acute on low-cost platforms, where the linear current-to-torque relation $τ= K_tI$ becomes unreliable during commanded-target tracking because of friction, hysteresis, backlash, and thermal effects. We present NeuralActuator, a neural actuator model that jointly predicts (i) a simulator-equivalent generalized-effort surrogate for trajectory propagation on low-cost servo platforms, (ii) external force with a contact-probability gate for sensorless force perception, and (iii) a motor-condition score for the supervised joint. We also introduce the Neural Actuation Dataset (NAD), collected with a twin-arm teleoperation system that records robot states and actuator telemetry together with external-force labels. The torque-surrogate head is trained through differentiable simulation from pose trajectories without direct generalized-effort labels, while the force, gate, and motor-condition heads receive direct supervision. A Transformer captures temporal dependencies while supporting real-time inference. We evaluate NeuralActuator on a 5-DoF OpenManipulator-X, a 6-DoF SO-101, and a 7-DoF Franka Emika Panda, spanning three actuator families and platforms costing approximately USD 500 to over USD 30,000. The low-cost platforms support dynamics and force evaluation, while the offline Franka experiment provides an additional payload-force-estimation benchmark. Experiments further demonstrate its application for motor condition estimation on OpenManipulator-X and improved behavior-cloning performance when NeuralActuator is used as a pretrained module.