Head Stabilization Research Articles

Use of ultrasonography to evaluate early outcomes of reduction in developmental dysplasia of the hip.

To compare pubo-femoral distance (PFD) in normal hips and those treated for developmental dysplasia of the hip (DDH) and to investigate the value of ultrasonography from the medial hip in early follow-up of dislocated DDH after reduction. This study included 58 infants (49 females) with DDH who presented with 65 dislocated hips (51 unilateral and 7 bilateral). Dislocation was treated by closed reduction for 53 and open reduction for 12 hips. Ultrasonography on the medial side of the hip was performed within 1-2weeks and 4weeks after reduction. The distance from the pubic bone to the femoral head (PFD) was measured to assess the reduction and stability of the femoral head and compared to that on the contralateral side (control) in cases of unilateral DDH. The PFD value for the normal group (2.9 ± 0.4mm) was significantly less than that for the closed reduction group (4.9 ± 2.8mm, P<0.001) and that for the open reduction group (4.4 ± 1.6mm; P=0.02), but no difference in the PFD was observed between the closed reduction and the open reduction groups (P=0.73). Despite successful reduction, the PFD values in the successful reduction group remained higher than those of the normal hips. PFD measurement by ultrasonography of the medial hip can be used to evaluate the effectiveness of reduction procedures in DDH. The clinical implications of post-reduction ultrasound evaluation in the diagnosis and long-term follow-up of outcomes require further research.

Patient-specific 3D-printed shelf implant for the treatment of hip dysplasia tested in an experimental animal pilot in canines

The concept of a novel patient-specific 3D-printed shelf implant should be evaluated in a relevant large animal model with hip dysplasia. Therefore, three dogs with radiographic bilateral hip dysplasia and a positive subluxation test underwent unilateral acetabular augmentation with a 3D-printed dog-specific titanium implant. The contralateral side served as control. The implants were designed on CT-based pelvic bone segmentations and extended the dysplastic acetabular rim to increase the weight bearing surface without impairing the range of motion. Outcome was assessed by clinical observation, manual subluxation testing, radiography, CT, and gait analysis from 6 weeks preoperatively until termination at 26 weeks postoperatively. Thereafter, all hip joints underwent histopathological examination. The implantation and recovery from surgery was uneventful. Clinical subluxation tests at the intervention side became negative. Imaging showed medialization of the femoral head at the intervention side and the mean (range) CE-angle increased from 94° (84°–99°) preoperative to 119° (117°–120°) postoperative. Gait analysis parameters returned to pre-operative levels after an average follow-up of 6 weeks. Histology showed a thickened synovial capsule between the implant and the femoral head without any evidence of additional damage to the articular cartilage compared to the control side. The surgical implantation of the 3D shelf was safe and feasible. The patient-specific 3D-printed shelf implants restored the femoral head coverage and stability of dysplastic hips without complications. The presented approach holds promise to treat residual hip dysplasia justifying future veterinary clinical trials to establish clinical effectiveness in a larger cohort to prepare for translation to human clinic.

Bumblebees display characteristics of active vision during robust obstacle avoidance flight.

Insects are remarkable flyers and capable of navigating through highly cluttered environments. We tracked the head and thorax of bumblebees freely flying in a tunnel containing vertically oriented obstacles to uncover the sensorimotor strategies used for obstacle detection and collision avoidance. Bumblebees presented all the characteristics of active vision during flight by stabilizing their head relative to the external environment and maintained close alignment between their gaze and flightpath. Head stabilization increased motion contrast of nearby features against the background to enable obstacle detection. As bees approached obstacles, they appeared to modulate avoidance responses based on the relative retinal expansion velocity (RREV) of obstacles and their maximum evasion acceleration was linearly related to RREVmax. Finally, bees prevented collisions through rapid roll manoeuvres implemented by their thorax. Overall, the combination of visuo-motor strategies of bumblebees highlights elegant solutions developed by insects for visually guided flight through cluttered environments.

The Effect of Head and Neck Stabilization Exercises on Dynamic Balance in the Elderly With Forward Head Posture

Introduction: This study aimed to investigate the effect of head and neck stabilization exercises on improving balance in older adults with forward head posture. Materials and Methods: Thirty elderly participants with forward head posture and Mean±SD age of 65.7±5.2 years were examined. The forward head posture was measured by plumb line and craniovertebral angle. Elderly balance was evaluated before and after 8 weeks of head and neck stabilization exercises with Timed Up and Go (TUG) and Functional Reach (FR) tests. The paired t-test was used to examine the changes that occurred after the intervention. Results: The results showed that head and neck stabilization exercises in the elderly significantly changed TUG test (8.3 s before the intervention, 7.8 s after the intervention; P=0.03) and FR test (23.4 cm before the intervention, 24.7 cm after the intervention; P=0.01) omitted. No significant statistical changes were observed in the amount of the craniovertebral angle after the intervention. Conclusion: Based on the study results, performing the head and neck stabilization exercises did not cause significant changes in the craniovertebral angle but improved the dynamic balance of the elderly.

Pseudonystagmus in progressive supranuclear palsy

Ocular oscillations often have critical role in diagnostic algorithm of neurodegenerative disorders. Nystagmus, if present in parkinsonian syndrome, suggests cerebellar involvement that is typical of multiple system atrophy. We found vertical jerky oscillations of the eyes during oculographic assessments using head-fixed corneal curvature trackers in six patients with progressive supranuclear palsy. The oscillations were eliminated by adequate head stabilization of the patients. Although this phenomenon gave the initial impression of “downbeat nystagmus”, the oscillations were phase locked and frequency matched with subtle jerky head oscillations. We interpreted such jerky eye oscillations as “pseudonystagmus” representing the vestibulo-ocular reflex in response to involuntary subtle jerky head oscillations in our patients. This study further emphasizes the importance of head stabilization during instrumented or clinical assessment of gaze holding.

Sex Differences in Neck Strength Force and Activation Patterns in Collegiate Contact Sport.

The purpose of this study was to assess changes in cervical musculature throughout contact-heavy collegiate ice hockey practices during a regular season of NCAA Division III ice hockey teams. In this cross-sectional study, 36 (male n = 13; female n = 23) ice hockey players participated. Data were collected over 3 testing sessions (baseline; pre-practice; post-practice). Neck circumference, neck length, head-neck segment length, isometric strength and electromyography (EMG) activity for flexion and extension were assessed. Assessments were completed approximately 1h before a contact-heavy practice and 15 min after practice. For sternocleidomastoid (SCM) muscles, males had significantly greater peak force and greater time to peak force versus females. For both left and right SCMs, both sexes had significantly greater peak EMG activity pre-practice versus baseline, and right (dominant side) SCM time to peak EMG activity was decreased post-practice compared to pre-practice. There were no significant differences for EMG activity of the upper trapezius musculature, over time or between sexes. Sex differences observed in SCM force and activation patterns of the dominant side SCM may contribute to head stabilization during head impacts. Our study is the first investigation to report changes in cervical muscle strength in men's and women's ice hockey players in the practical setting.

HGC: Hypergraph‐based dynamic stable clustering scheme model for vehicular ad‐hoc networks (VANETs)

SummaryVehicular ad‐hoc network (VANET) is the unstructured evolving conception of a wireless network; clustering in these networks is perplexing due to continuously varying topology and recurrent disconnection in networks. The cluster head (CH) stability plays a noticeable role in robustness and scalability in the network. The author designs a model that includes cluster generation and maintenance. The cluster formation is conceived on the notion that the changes that are brought about due to the vehicle's speed are inevitable. A directed hypergraph approach is used to comprehend this problem, and then, based on the spectral clustering through tensor trace maximization, an optimal number of the cluster is formed. The centers of these clusters are used to place the auxiliary facilities that aid cluster maintenance. In the maintenance phase, the author has envisioned a CH selection method based on a summed amalgamation of three metrics: link lifetime, cooperative connectivity level, and relative cooperative speed superimposed on the vehicular hypergraph network to design the metric for choosing a stable CH. The proposed scheme is tested on the old Delhi area that includes a market area with urban inclusion. Also, the area is highly crowded as being the marketplace. The region also has a tourist attraction as being part of the heritage of Delhi. The traffic density and the variety are high in peak hours—a complete analysis of the different vehicular mobility and routing analysis. The analysis done through microscopic and macroscopic parameters has projected significant improvement in the CH stability and a promising solution for dynamic networks.

The Effect of Head and Neck Stabilization Exercises on Dynamic Balance in the Elderly With Forward Head Posture

The Effect of Head and Neck Stabilization Exercises on Dynamic Balance in the Elderly With Forward Head Posture

Effect of Balance in Home Program Training with Head and Neck Stability Device for Teenagers with Cerebral Palsy-A Preliminary Report

Effect of Balance in Home Program Training with Head and Neck Stability Device for Teenagers with Cerebral Palsy-A Preliminary Report

An Accessible, 16-Week Neck Strength Training Program Improves Head Kinematics Following Chest Perturbation in Young Soccer Athletes.

Neck size and strength may be associated with head kinematics and concussion risks. However, there is a paucity of research examining neck strengthening and head kinematics in youths. In addition, neck training is likely lacking in youth sport due to a perceived inadequacy of equipment or time. Examine neck training effects with minimal equipment on neck strength and head kinematics following chest perturbations in youth athletes. Single-group, pretest-posttest case series. Athlete training center. Twenty-five (14 men and 11 women) youth soccer athletes (9.8 [1.5]y). Sixteen weeks of twice-weekly neck-focused resistance training utilizing bands, body weight, and manual resistance. Head kinematics (angular range of motion, peak anterior-posterior linear acceleration, and peak resultant linear acceleration) were measured by an inertial motion unit fixed to the apex of the head during torso perturbations. Neck-flexion and extension strength were assessed using weights placed on the forehead and a plate-loaded neck harness, respectively. Neck length and circumference were measured via measuring tape. Neck extension (increase in median values for all: +4.5kg, +100%, P < .001; females: +4.5kg, +100%, P = .002; males: +2.2kg, +36%, P = .003) and flexion (all: +3.6kg, +114%, P < .001; females: +3.6kg, +114%, P = .004; males: +3.6kg, +114%, P = .001) strength increased following the intervention. Men and women both experienced reduced perturbation-induced head pitch (all: -84%, P < .001). However, peak resultant linear acceleration decreased in the female (-53%, P = .004), but not male (-31%, P = 1.0) subgroup. Preintervention peak resultant linear acceleration and extension strength (R2 = .21, P = .033) were the closest-to-significance associations between head kinematics and strength. Young athletes can improve neck strength and reduce perturbation-induced head kinematics following a 16-week neck strengthening program. However, further research is needed to determine the effect of improved strength and head stabilization on concussion injury rates.

Inflight head stabilization associated with wingbeat cycle and sonar emissions in the lingual echolocating Egyptian fruit bat, Rousettus aegyptiacus.

Sensory processing of environmental stimuli is challenged by head movements that perturb sensorimotor coordinate frames directing behaviors. In the case of visually guided behaviors, visual gaze stabilization results from the integrated activity of the vestibuloocular reflex and motor efference copy originating within circuits driving locomotor behavior. In the present investigation, it was hypothesized that head stabilization is broadly implemented in echolocating bats during sustained flight, and is temporally associated with emitted sonar signals which would optimize acoustic gaze. Predictions from these hypotheses were evaluated by measuring head and body kinematics with motion sensors attached to the head and body of free-flying Egyptian fruit bats. These devices were integrated with ultrasonic microphones to record sonar emissions and elucidate the temporal association with periods of head stabilization. Head accelerations in the Earth-vertical axis were asymmetric with respect to wing downstroke and upstroke relative to body accelerations. This indicated that inflight head and body accelerations were uncoupled, outcomes consistent with the mechanisms that limit vertical head acceleration during wing downstroke. Furthermore, sonar emissions during stable flight occurred most often during wing downstroke and head stabilization, supporting the conclusion that head stabilization behavior optimized sonar gaze and environmental interrogation via echolocation.

Intramedullary headless compression screw fixation for midshaft fractures of the clavicle: A case report study

Historically, displaced midshaft clavicle fractures have been managed conservatively. However, recent literature has supported operative management of displaced and shortened clavicle fractures. Several options exist for surgical fixation, including plating and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure and less prominent hardware.Rockwood and Hagie pins represented the most popular form of IM fixation during the last two decades,but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, prominent screw head and construct stability. Our technique describes intramedullary fixation of midshaft clavicle fractures using a single headless compression screw (HCS) 4.5–6.5-mm. which is simple, affordable, and allows intramedullary compression, stability, load sharing, little periosteal stripping, very limited skin incision and rapid recovery after surgery.

An interactive eye-tracking system for measuring radiologists' visual fixations in volumetric CT images: Implementation and initial eye-tracking accuracy validation.

Eye-tracking approaches have been used to understand the visual search process in radiology. However, previous eye-tracking work in computer tomography (CT) has been limited largely to single cross-sectional images or video playback of the reconstructed volume, which do not accurately reflect radiologists' visual search activities and their interactivity with three-dimensional image data at a computer workstation (e.g., scroll, pan, and zoom) for visual evaluation of diagnostic imaging targets. We have developed a platform that integrates eye-tracking hardware with in-house-developed reader workstation software to allow monitoring of the visual search process and reader-image interactions in clinically relevant reader tasks. The purpose of this work is to validate the spatial accuracy of eye-tracking data using this platform for different eye-tracking data acquisition modes. An eye-tracker was integrated with a previously developed workstation designed for reader performance studies. The integrated system captured real-time eye movement and workstation events at 1000Hz sampling frequency. The eye-tracker was operated either in head-stabilized mode or in free-movement mode. In head-stabilized mode, the reader positioned their head on a manufacturer-provided chinrest. In free-movement mode, a biofeedback tool emitted an audio cue when the head position was outside the data collection range (general biofeedback) or outside a narrower range of positions near the calibration position (strict biofeedback). Four radiologists and one resident were invited to participate in three studies to determine eye-tracking spatial accuracy under three constraint conditions: head-stabilized mode (i.e., with use of a chin rest), free movement with general biofeedback, and free movement with strict biofeedback. Study 1 evaluated the impact of head stabilization versus general or strict biofeedback using a cross-hair target prior to the integration of the eye-tracker with the image viewing workstation. In Study 2, after integration of the eye-tracker and reader workstation, readers were asked to fixate on targets that were randomly distributed within a volumetric digital phantom. In Study 3, readers used the integrated system to scroll through volumetric patient CT angiographic images while fixating on the centerline of designated blood vessels (from the left coronary artery to dorsalis pedis artery). Spatial accuracy was quantified as the offset between the center of the intended target and the detected fixation using units of image pixels and the degree of visual angle. The three head position constraint conditions yielded comparable accuracy in the studies using digital phantoms. For Study 1 involving the digital crosshairs, the median ± the standard deviation of offset values among readers were 15.2 ± 7.0 image pixels with the chinrest, 14.2 ± 3.6 image pixels with strict biofeedback, and 19.1 ± 6.5 image pixels with general biofeedback. For Study 2 using the random dot phantom, the median ± standard deviation offset values were 16.7 ± 28.8 pixels with use of a chinrest, 16.5 ± 24.6 pixels using strict biofeedback, and 18.0 ± 22.4 pixels using general biofeedback, which translated to a visual angle of about 0.8° for all three conditions. We found no obvious association between eye-tracking accuracy and target size or view time. In Study 3 viewing patient images, use of the chinrest and strict biofeedback demonstrated comparable accuracy, while the use of general biofeedback demonstrated a slightly worse accuracy. The median ± standard deviation of offset values were 14.8 ± 11.4 pixels with use of a chinrest, 21.0 ± 16.2 pixels using strict biofeedback, and 29.7 ± 20.9 image pixels using general biofeedback. These corresponded to visual angles ranging from 0.7° to 1.3°. An integrated eye-tracker system to assess reader eye movement and interactive viewing in relation to imaging targets demonstrated reasonable spatial accuracy for assessment of visual fixation. The head-free movement condition with audio biofeedback performed similarly to head-stabilized mode.

Reflexive Response of Neck Muscle to Sudden Perturbation after Prolonged Smartphone Use

Prolonged smartphone use induces passive stretch of neck tissues and muscle fatigue, affecting spinal stability and pain. It is necessary to evaluate the effect of smartphone use on the reflexive response to detect the changes in neck tissues and head stability. A laboratory experiment (n=10) was conducted to investigate the reflexive response of neck muscle to perturbation after 30 minutes of smartphone use. Neck extensor muscle activation and its activation timing to perturbation were investigated before and after smartphone use. Head angle and muscle activation level were collected during smartphone use. During smartphone use, muscle activation gradually increased. After smartphone use, neck muscles showed a higher activation level and significantly delayed onset to perturbation. Smartphone use changed the reflexive response of the neck muscle. Further study is needed to investigate the association between smartphone use and neuromuscular changes to the tissues of the cervical spine.

Stability-Delay Efficient Cluster-based Routing Protocol for VANET

Vehicular Ad hoc Network (VANET) can be used in safety applications to transfer information about some events (e.g. accidents) with minimum time. Sending this information is achieved by using a routing algorithm. A large number of cluster-based routing schemes were presented for VANET. Unfortunately, the mobility of vehicles in unexpected directions negatively affects the performance of these schemes, destroys the network links, and decreases the routes' stability. This problem leads to repeat route discovery and maintenance operations and, as a result increases the overhead and delay. Thus, they are not an optimal selection for safety applications. Moreover, the cluster-based policies need efficient clustering approaches, but the previous ones fail to enhance the stability of links and cluster heads. Moreover, they did not focus on the stability of gateways. Therefore, a new clustering formation approach that focuses on the stability of cluster head and gateway is proposed. It gives priority to the parked and stopped vehicles to be cluster heads and gateways. Moreover, a new cluster-based routing protocol to build optimal paths with minimum delay and maximum stability called CRDS is suggested for safety applications. CRDS depends on the suggested clustering approach and computes the optimal routes depending on a novel suggested optimization model. Several simulation scenarios with various mobility speeds and numbers of stopped and parked vehicles have been run. The results showed that CRDS is better than LRCA, PASRP and CVoEG according to network overhead, average end to end delay, path stability, cluster head stability, and packet delivery ratio.

Head and eyes: Looking behavior in 12- to 24-month-old infants.

This study demonstrates evidence for a foundational process underlying active vision in older infants during object play. Using head-mounted eye-tracking and motion capture, looks to an object are shown to be tightly linked to and synchronous with a stilled head, regardless of the duration of gaze, for infants 12 to 24 months of age. Despite being a developmental period of rapid and marked changes in motor abilities, the dynamic coordination of head stabilization and sustained gaze to a visual target is developmentally invariant during the examined age range. The findings indicate that looking with an aligned head and eyes is a fundamental property of human vision and highlights the importance of studying looking behavior in freely moving perceivers in everyday contexts, opening new questions about the role of body movement in both typical and atypical development of visual attention.

Proximal Overresection During Femoral Osteochondroplasty Negatively Affects the Distractive Stability of the Hip Joint: A Cadaver Study

Background: Contact between the acetabular labrum and articular cartilage of the femoral head creates a suction seal that helps maintain stability of the femoral head in the acetabulum. A femoral osteochodroplasty may occasionally extend proximally into the femoral head, diminishing the articular surface area available for sealing contact. Purpose: To determine whether proximal overresection decreases the rotational and distractive stability of the hip joint. Study Design: Controlled laboratory study. Methods: Six hemipelvises in the following conditions were tested: intact, T-capsulotomy, osteochondroplasty to the physeal scar, and 5- and 10-mm proximal extension. The pelvis was secured to a metal plate, and the femur was potted and attached to a multiaxial hip jig. Specimens were axially distracted using a load from 0 to 150 N. For rotational stability testing, 5 N·m of internal and external torque was applied. Both tests were performed at different angles of flexion (0°, 15°, 30°, 60°, 90°). Displacement and rotation were recorded using a 3-dimensional motion tracking system. Results: The T-capsulotomy decreased the distractive stability of the hip joint. A femoral osteochondroplasty up to the physeal scar did not seem to affect the distractive stability. However, a proximal extension of the resection by 5 and 10 mm increased axial instability at every angle of flexion tested, with the greatest increase observed at larger angles of flexion (P < .01). External rotation increased significantly after T-capsulotomy in smaller angles of flexion (0°, P = .01; 15°, P = .01; 30°, P = .03). Femoral osteochondroplasty did not create further external rotational instability, except when the resection was extended 10 mm proximally and the hip was in 90° of flexion (P = .04). Conclusion: This cadaveric study demonstrated that proximal extension of osteochondroplasty into the femoral head compromises the distractive stability of the hip joint but does not affect hip rotational stability. Clinical Relevance: Clinically, this study highlights the importance of accuracy when performing femoral osteochondroplasty to minimize proximal extension that may increase iatrogenic instability of the hip joint.

Deep Learning-Based Dynamic Stable Cluster Head Selection in VANET

VANET is the spontaneous evolving creation of a wireless network, and clustering in these networks is a challenging task due to rapidly changing topology and frequent disconnection in networks. The cluster head (CH) stability plays a prominent role in robustness and scalability in the network. The stable CH ensures minimum intra- and intercluster communication, thereby reducing the overhead. These challenges lead the authors to search for a CH selection method based on a weighted amalgamation of four metrics: befit factor, community neighborhood, eccentricity, and trust. The stability of CH depends on the vehicle’s speed, distance, velocity, and change in acceleration. These all are included in the befit factor. Also, the accurate location of the vehicle in changing the model is very vital. Thus, the predicted location with the Kalman filter’s help is used to evaluate CH stability. The results have shown better performance than the existing state of the art for the befit factor. The change in dynamics and frequent disconnection in communication links due to the vehicle’s high speed are inevitable. To comprehend this problem, a graphing approach is used to evaluate the eccentricity and the community neighborhood. The link reliability is calculated using the eigengap heuristic. The last metric is trust; this is one of the concepts that has not been included in the weighted approach to date as per the literature. An adaptive spectrum sensing is designed for evaluating the trust values specifically for the primary users. A deep recurrent learning network, commonly known as long short-term memory (LSTM), is trained for the probability of detection with various signals and noise conditions. The false rate has drastically reduced with the usage of LSTM. The proposed scheme is tested on the real map of Chengdu, southwestern China’s Sichuan province, with different vehicular mobilities. The comparative study with the individual and weighted metric has shown significant improvement in the cluster head stability during high vehicular density. Also, there is a considerable increase in network performance in energy, packet delay, packet delay ratio, and throughput.

Contactless optical coherence tomography of the eyes of freestanding individuals with a robotic scanner.

Clinical systems for optical coherence tomography (OCT) are used routinely to diagnose and monitor patients with a range of ocular diseases. They are large tabletop instruments operated by trained staff, and require mechanical stabilization of the head of the patient for positioning and motion reduction. Here we report the development and performance of a robot-mounted OCT scanner for the autonomous contactless imaging, at safe distances, of the eyes of freestanding individuals without the need for operator intervention or head stabilization. The scanner uses robotic positioning to align itself with the eye to be imaged, as well as optical active scanning to locate the pupil and to attenuate physiological eye motion. We show that the scanner enables the acquisition of OCT volumetric datasets, comparable in quality to those of clinical tabletop systems, that resolve key anatomic structures relevant for the management of common eye conditions. Robotic OCT scanners may enable the diagnosis and monitoring of patients with eye conditions in non-specialist clinics.

Evaluating cost function criteria in predicting healthy gait

Accurate predictive simulations of human gait rely on optimisation criteria to solve the system’s redundancy. Defining such criteria is challenging, as the objectives driving the optimization of human gait are unclear. This study evaluated how minimising various physiologically-based criteria (i.e., cost of transport, muscle activity, head stability, foot–ground impact, and knee ligament use) affects the predicted gait, and developed and evaluated a combined, weighted cost function tuned to predict healthy gait.A generic planar musculoskeletal model with 18 Hill-type muscles was actuated using a reflex-based, parameterized controller. First, the criteria were applied into the base simulation framework separately. The gait pattern predicted by minimising each criterion was compared to experimental data of healthy gait using coefficients of determination (R2) and root mean square errors (RMSE) averaged over all biomechanical variables. Second, the optimal weighted combined cost function was created through stepwise addition of the criteria. Third, performance of the resulting combined cost function was evaluated by comparing the predicted gait to a simulation that was optimised solely to track experimental data.Optimising for each of the criteria separately showed their individual contribution to distinct aspects of gait (overall R2: 0.37–0.56; RMSE: 3.47–4.63 SD). An optimally weighted combined cost function provided improved overall agreement with experimental data (overall R2: 0.72; RMSE: 2.10 SD), and its performance was close to what is maximally achievable for the underlying simulation framework. This study showed how various optimisation criteria contribute to synthesising gait and that careful weighting of them is essential in predicting healthy gait.