Prolonged swing phase rectus femoris activity is not associated with stiff-knee gait in children with cerebral palsy: A retrospective study of 407 limbs

Prolonged swing phase rectus femoris (RF) activity has been implicated as a cause of stiff-knee gait (SKG) in children with cerebral palsy (CP) and continues to be cited as an indicator for RF intervention. The purpose of this study was to determine what, if any, association exists between abnormal RF activity during preswing, initial swing and/or midswing and SKG in children with CP. This retrospective analysis involved three examiners independently reviewing sagittal plane knee kinematic and RF surface electromyographic (EMG) data from 407 affected limbs of 234 pediatric patients with CP. Five kinematic parameters were rated by each examiner as normal or pathologic: peak knee flexion, knee range of motion during initial swing, total knee range of motion, peak knee flexion timing, and rate of knee flexion. These ratings were used to classify each limb into one of three groups: SKG, Borderline SKG, or Non-SKG. From a representative EMG tracing, RF activity was examined during: the first half of preswing, the latter 2/3 of initial swing, and midswing. Chi-squared tests were used to determine if significant associations existed between SKG and RF activation during these three subphases. There was no association between SKG and prolonged RF activity during the latter 2/3 of initial swing or during midswing. However, a significant relationship between SKG and RF activity during the first half of preswing was found (p < 0.001). Neither prolonged RF activity during initial swing, nor the presence of RF activity during midswing, were associated with SKG, thus refuting these commonly held associations.

► Qualitative analysis of gait kinematics is a valid way to identify patients with and without stiff-knee gait (SKG). ► Prolonged rectus femoris (RF) activity during swing phase is not associated with SKG in children with cerebral palsy (CP). ► Premature RF activity in preswing is related to swing phase SKG in children with CP. ► Abnormal swing phase RF activity is prevalent in children with CP regardless of SKG. ► Abnormal swing phase RF EMG activity should not be utilized as an indicator for RF intervention for SKG in children with CP.