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Prof. Dr. med. Dr. phil. Heide Elke Viehweger

Department of Biomedical Engineering
Profiles & Affiliations

Clinical Biomechanics and Musculoskeletal Modelling

In the research projects of the group, we establish the link from neuroorthopaedics to the redefinition of modern and dynamic pediatric orthopedics. This not only places the clinical researcher at the junction of different medical (orthopedics, physical medicine and rehabilitation, neurology, neurosurgery, ...) and paramedical fields, but, also includes epidemiology, public health, engineering, biomechanics, and digital health aspects.

These deal with the combination of different epidemiological, clinical, functional, and technical evaluation methods within the pathophysiological study of pediatric orthopedic injuries, as well as with the results of therapeutic management ("outcome evaluation") based on the framework of the International Classification of Functioning, Disability and Health (ICF).


The group explores the multifactorial adaptations and interplay among nervous-, musculoskeletal-, and psychological systems and how they impact walking behavior in various walking conditions, including a virtual reality environment. The principal focus is to understand the modification of control mechanisms and effectors due to the variation of stability conditions in neurological and non-neurological patients (orthopedic deformities of the lower limb and spine, sports).


Furthermore, new treatment approaches were explored, such as the influence of functional strength training on motion performance and daily life stability of cerebral palsy patients where the group has shown a direct translation of their clinical research in the improvement of daily life conditions in cerebral palsy patients.

Selected Publications

Sangeux, Morgan, Viehweger, Elke, Romkes, Jacqueline, & Bracht-Schweizer, Katrin. (2024). On the clinical interpretation of overground gait stability indices in children with cerebral palsy [Posted-content]. Research Square Platform LLC. https://doi.org/10.21203/rs.3.rs-3900116/v1

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Minghetti, Alice, Widmer, Michèle, Viehweger, Elke, Roth, Ralf, Gysin, Ramon, & Keller, Martin. (2024). Translating scientific recommendations into reality: a feasibility study using group-based high-intensity functional exercise training in adolescents with cerebral palsy [Journal-article]. Disability and Rehabilitation, 46(20), 4787–4796. https://doi.org/10.1080/09638288.2023.2290204

Cartier, T., Rao, G., Viehweger, E., & Vigouroux, L. (2023). Evolution of muscle coordination and mechanical output throughout four weeks of arm cranking submaximal training [Journal-article]. Journal of Neurophysiology, 129(3), 541–551. https://doi.org/10.1152/jn.00425.2022

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De Pieri E, Nüesch C, Pagenstert G, Viehweger E, Egloff C, & Mündermann A. (2023). High tibial osteotomy effectively redistributes compressive knee loads during walking. Journal of Orthopaedic Research, 41(3), 591–600. https://doi.org/10.1002/jor.25403

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Visscher, Rosa M. S., Gwerder, Michelle, Viehweger, Elke, Taylor, William R., Brunner, Reinald, & Singh, Navrag B. (2023). Can developmental trajectories in gait variability provide prognostic clues in motor adaptation among children with mild cerebral palsy? A retrospective observational cohort study. Frontiers in Human Neuroscience, 17. https://doi.org/10.3389/fnhum.2023.1205969

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Selected Projects & Collaborations

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Patient-specific musculoskeletal models to predict surgical outcome

Research Project  | 3 Project Members

Instrumented clinical gait analysis is used routinely to inform decision-making in neuro-orthopaedics. In addition to gait analysis, musculoskeletal modeling may become a powerful and non-invasive tool to guide clinical management and predict treatment outcomes. However, musculoskeletal modeling needs to integrate patient-specific adaptations, and its outputs need to be validated on a larger scale before it may be used in standard clinical practice.

The goal of this project is to develop patient-specific gait simulations by means of an open-source musculoskeletal modeling software. Results will be validated against existing clinical data pre vs post a typical intervention in neuro-orthopaedics.

Personalized musculoskeletal models from 30 children who received botulinum toxin injection will be developed from gait analysis data obtained before the intervention. To predict patient's response, the botulinum toxin effect will be simulated by weakening the model muscle and running a forward dynamic simulation. I will compare the outcome against existent data post-injection and analyze how induced muscle weakness alters the gait of children with cerebral palsy, providing validation for this specific musculoskeletal modeling application and overall confidence in our framework reliability.


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Getting high level of evidence for surgical treatments from routine clinical data. A real-world testing of the SPHN infrastructure - EVIGAITCP

Research Networks (Institutional Membership)  | 4 Project Members

Cerebral palsy is the first cause of disability with a prevalence of about 2.5 in 1000 children born in developed countries, that is about 250 children every year in Switzerland. The primary cause of cerebral palsy is a brain lesion occurring shortly before or after birth. The brain lesion is static and does not progress with time but secondary consequences, such as joint contractures and bony deformities develop during childhood and adolescence. A variety of surgical interventions and orthotics prescriptions may be performed to improve the biomechanical capacity of the musculoskeletal system once the deformities have developed.

However, ethical and practical difficulties to organise randomised controlled trials within the field of surgery have led to low or moderate level of evidence to support the interventions. In addition, different patients may respond markedly differently to the same treatment. In this context, the principles of evidence-based medicine are difficult to apply by clinicians when choosing the most appropriate treatment for a given child, or when discussing their rationale with the families.

Since the 90s, instrumented gait analysis has been utilised to inform the clinical decision-making process, plan the details of surgical interventions when these are deemed necessary, and evaluate the outcome of these interventions. Instrumented gait analysis provides quantitative and objective measures of the walking function. It generates a rich dataset composed of more than 50 scalar values describing the lower limb anatomy and functioning as well as more than 80 waveforms describing the walking pattern of the patients.


In this project, routine clinical data collected in two leading gait analysis centres at the UKBB (Basel) and at the HUG (Geneva) will be connected to the SPHN infrastructure. The objectives of the project are to ensure the SPHN | Swiss Personalized Health Network 2 | 4 interoperability of gait analysis data collected in different clinical centres in Switzerland and internationally, to determine the causal treatment effect of some of the most common orthopaedic treatments to improve walking in children with cerebral palsy, and to quantify the added value of multicentric observational datasets.

This project aims to lay the foundation for national, and international, gait analysis data interoperability as well as support evidence-based clinical decision-making in the field of neuro-orthopaedics for children with cerebral palsy. 

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CADENCE - Clinical Biomechanics and Ergonomics Engineering Equipment

Research Project  | 5 Project Members

In December 2021, the new research unit ‘Clinical Biomechanics and Ergonomics Engineering’ (CADENCE) was formed at Department of Biomedical Engineering (DBE) at the University of Basel (https://dbe.unibas.ch/en/research/biomechanics-and-biomaterials/cadence/) comprising the research groups ‘Functional Biomechanics’, ‘Robot-assisted Theragnostics’, ‘Paediatric Orthopaedic Biomechanics and Musculoskeletal Modelling’, and ‘Spine Biomechanics’. CADENCE facilitates innovative and groundbreaking interdisciplinary research in biomedical engineering and biomechanics and serves as teaching facility for courses on diagnostic and therapeutic technologies within the new Master of Science program and the PhD programs at the DBE. The R`Equip grant supports CADENCE in the purchase of a range of state-of-the-art sensor technologies and the world’s first 3D gait rehabilitation robot ‘The FLOAT’. This investment is critical for the unique and internationally leading role of the research groups in the research and innovation ecosystem in the Basel region.

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Stop tip-toeing around toe-walking: towards a better understanding and more effective treatment of toe-walkers with cerebral palsy

Research Project  | 8 Project Members

Background and Rationale: Walking is the most common and necessary form of movement for humans, as it ensures active participation in activities of daily life. In the initial stages of learning to walk, gait is rather unstable as well as variable. During this initial phase, children need to successfully perform the entire gait cycle that involves touch-down (characteristic heel-strike where the ankle is flexed), lift-off and swing phases. The characteristic heel-strike is critical to walking both effectively (stable) and efficiently (energy). Children that suffer from neuro-developmental disorders (e.g. cerebral palsy, CP) are often not able to heel-strike, they tend to keep walking with a forefoot or flatfoot pattern (i.e. toe-walking). Children that toe-walk often show poorer levels of static and dynamic stability, leading to a lower quality of life compared to typically developing children (TD). Current research suggests multifactorial adaptations in central and/or peripheral nervous as well as the musculoskeletal system contribute to and result from toe-walking. Current treatment mainly focuses on physically restoring the capability to heel-strike, however, adherence to walking with heel-strike is poor. From clinical experience, we hypothesize psychological factors (primarily fear-of-falling) as well as inadequate reflex control might contribute to toe-walking behavior. Currently, the interplay between the nervous-, musculoskeletal-, and psychological systems and their impact on resulting walking patterns are poorly understood. In order to sustain effective gait by means of effective interventions, it is therefore critical to understand the interplay among the mechanisms that underpin toe-walking adaptation. Overall Objectives & Specific Aims: The purpose of this study is to explore the interplay among nervous-, musculoskeletal-, and psychological systems and how they impact toe-walking behavior, and vice versa. Here, we will determine the effect of psychological factors (via the use of a custom-designed virtual reality environment) on static vs. dynamic stability, motor control and coordination (indirect assessment of central nervous system function), as well as reflex control (Hoffmann-reflex, H-reflex, performance of peripheral nervous system). In addition, we will also investigate the effect of restoring heel striking in toe-walkers based on the indices as mentioned above. Expected Results: It is expected that toe-walkers will show poorer stability during standing and walking, have a reduced H-reflex amplitude, reduced number of muscle synergies as well as increased fear-of-falling compared to TD. With the use of a custom-made virtual reality (VR) environment, the fear-of-falling in children will be increased. VR induced fear-of-falling will lead to poorer stability during standing and walking tasks in TD; in toe-walkers such reactions are present already without VR but worsen during VR conditions. By restoring (via the use of orthoses) heel-strike in toe-walkers stability during standing and walking tasks will be improved, number of muscle synergies will be increased, fear-of-falling will be reduced, and performance on VR induced fear-of-falling will be improved. Impact: Although development of heel-strike behavior takes place early in life, not all children demonstrate this feature during walking in daily life. Lack of heel-strike behavior is less efficient and leads to poorer quality of life. Management strategies to restore this critical feature of walking, have failed primarily due to the fact that although the capability might be restored, the adherence to walking with heel-strike is poor. By focusing on understanding the interplay between nervous-, musculoskeletal-, and psychological factors that might predispose individuals to toe-walking, we will provide solutions to design effective treatment strategies in the future.