Electrical Stimulation of the Rectus Femoris During Pre-Swing Diminishes Hip and Knee Flexion During the Swing Phase of Normal Gait

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Individuals who have suffered cerebral insults often exhibit stiff-knee gait, a condition characterized by reduced knee flexion during swing. We investigated the effect that an increment in normal rectus femoris (RF) activity can have on hip and knee joint angles during swing, as a first step to determining this muscle's involvement in stiff-knee gait. For this, we developed a protocol that electrically stimulated the RF during pre-swing or after toe-off in randomly selected strides of treadmill walking, consistent with the timing of RF activity during normal gait. Seven healthy young adults participated in the study. Pre-swing stimulation induced a significant (p < 0.05) reduction in peak knee flexion (avg 7.5°) in all subjects, with an accompanying decrease in hip flexion in four of the subjects. RF stimulation after toe-off diminished peak knee flexion in three subjects and reduced hip flexion in four subjects. When compared to muscle-actuated gait simulations that were similarly perturbed, the induced motion measures were generally consistent in direction but exhibited greater variability across strides and subjects. We conclude that excess RF activity during pre-swing has the potential to contribute to stiff-knee gait, and that clinical treatment should consider the "counter-intuitive" function that the RF has in extending the hip.