Biomechanics and muscle coordination of human walking: part II: lessons from dynamical simulations and clinical implications.

Principles of muscle coordination in gait have been based largely on analyses of body motion, ground reaction force and EMG measurements. However, data from dynamical simulations provide a cause-effect framework for analyzing these measurements; for example, Part I (Gait Posture, in press) of this two-part review described how force generation in a muscle affects the acceleration and energy flow among the segments. This Part II reviews the mechanical and coordination concepts arising from analyses of simulations of walking. Simple models have elucidated the basic multisegmented ballistic and passive mechanics of walking. Dynamical models driven by net joint moments have provided clues about coordination in healthy and pathological gait. Simulations driven by muscle excitations have highlighted the partial stability afforded by muscles with their viscoelastic-like properties and the predictability of walking performance when minimization of metabolic energy per unit distance is assumed. When combined with neural control models for exciting motoneuronal pools, simulations have shown how the integrative properties of the neuro-musculo-skeletal systems maintain a stable gait. Other analyses of walking simulations have revealed how individual muscles contribute to trunk support and progression. Finally, we discuss how biomechanical models and simulations may enhance our understanding of the mechanics and muscle function of walking in individuals with gait impairments.