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J Neurophysiol (September 26, 2007). doi:10.1152/jn.00726.2007
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00726.2007v1
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Submitted on June 28, 2007
Accepted on September 26, 2007

Prolonged Quadriceps Activity Following Imposed Hip Extension: A Neurophysiological Mechanism for Stiff-Knee Gait?

Michael D Lewek1*, T. George Hornby2, Yasin Y Dhaher3, and Brian D Schmit4

1 Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois, United States
2 Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois, United States; Dept of Physical Therapy, University of Illinois, Chicago, Chicago, Illinois, United States
3 Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois, United States; Dept of Biomedical Engineering, Northwestern University, Chicago, Illinois, United States
4 Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois, United States; Dept of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States

* To whom correspondence should be addressed. E-mail: mlewek{at}med.unc.edu.

Purpose: The biomechanical characteristics of stiff knee gait following neurological injury include decreased knee flexion velocity at toe-off, which may be due to exaggerated quadriceps activity. The neuromuscular mechanism underlying this abnormal activity is unclear, although hyperexcitable heteronymous reflexes may be a source of impaired coordination. The present study examines the contribution of reflex activity from hip flexors on knee extensors following stroke and its association with reduced swing phase knee flexion during walking. Methods: Twelve individuals post-stroke and 6 control subjects were positioned in supine on a Biodex dynamometer with the ankle and knee held in a static position. Isolated hip extension movements were imposed at 60, 90, and 120°/s through a 50° excursion to end-range hip extension. Reflexive responses of the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) were quantified during and following the imposed hip rotation. Gait analysis was also performed for all subjects in the stroke group. Results: In subjects with stroke, imposed hip extension evoked a brief reflexive response in the quadriceps, followed by a heightened level of sustained activity. The initial response was velocity dependent and was larger in the stroke vs. control group. In contrast, the prolonged response was not velocity dependent, was significantly greater in the VL and RF in subjects with stroke, and importantly, was correlated to decreased swing phase knee flexion. Conclusions: Hyperexcitable heteronymous connections from hip flexors to knee extensors appear to elicit prolonged quadriceps activity and may contribute to altered swing-phase knee kinematics following stroke.







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Copyright © 2007 by the The American Physiological Society.