Mechanisms of Post-Stroke Stiff Knee Gait: A Narrative Review.

Abstract: Stiff-Knee gait (SKG) is a dysfunction commonly observed post-stroke characterized by a decreased swing phase knee flexion angle. Importantly, SKG can impair walking, ultimately reducing overall activity and participation. Interventions for SKG have shown mixed results, and combined with more recent observational evidence, suggest that there are other potential causes requiring the need to re-examine the etiology of SKG. The aim of this review is to compile and appraise the current state of the science regarding the neurophysiological and biomechanical impairments of individuals post-stroke with SKG. This narrative review will address the following topics to better understand SKG: operationally define SKG and further detail its presentation, describe the potential neurophysiological and biomechanical mechanisms of SKG, and synthesize findings. We explore evidence for quadriceps hyperreflexia, abnormal tone, motor incoordination, and impaired propulsion. We conclude that SKG needs a commonly accepted definition, that more attention needs to be devoted to understanding its mechanisms, and that in prospective designs, larger sample sizes are needed to account for the heterogeneity of the condition.