Many neurological patients experience problems with walking or with balance. A common problem is decrease in knee flexion during the swing phase of walking. This stiff knee gait increases the risk of falling and is energetically very unfavorable for the patient. Conventional devices such as orthoses or custom footwear are not available for the stiff knee problem. Recent pilot research shows that stiff knee gait caused by overactivity of the rectus femoris can be remedied by Botulinum toxin injections or by a surgical procedure viz. rectus femoris transfer. However, little scientific research has been conducted on the efficacy and determinants of success of these two treatment options. Preliminary research indicates that walking speed may be a possible one determinant of success.


Purpose of the internship

The purpose of this internship is to determine if there is a relationship between the effect of Botulinum toxin injections and different walking speeds pre injection. In doing so, we will investigate whether gait speed can be a determinant of success. The result of the study will be used in the implementation of Botulinum toxin injections in rehabilitation.


Structure of the internship

In previously conducted RCT study with a crossover design, 25 patients were examined including a gait image analysis with VICON 3D Plug in Gait model. There were four measurements of each patient: before and after administration of Botulinum toxin injection and before and after administration of placebo. Pre-injection comfortable gait speed and fast gait speed were decreased. The comfortable walking speed has already been analyzed. For the internship assignment, fast walking speed will have to be analyzed mbv VICON, after which it should be investigated whether walking speed is a determinant of success and can be used in daily practice in the treatment of neurological patients. It can also be investigated whether the effect of a botulin injection has a predictive value for the effect of the subsequent treatment namely surgical intervention of the rectus femoris transfer.

During the internship there is the opportunity to be present during the treatment of rehabilitation patients and during e.g. gait analysis.


Duration of assignment: In consultation

Contact: M.Tenniglo, PhD, PT. Project leader Stiff Knee Gait project.