Abstract
Background: Proximal compensation to the distal movements is commonly observed in the affected upper extremity (UE) of patients with chronic stroke. However, the cortical origin of this compensation has not been well-understood. In this study, corticomuscular coherence (CMCoh) and electromyography (EMG) analysis were adopted to investigate the corticomuscular coordinating pattern of proximal UE compensatory activities when conducting distal UE movements in chronic stroke.Method: Fourteen chronic stroke subjects and 10 age-matched unimpaired controls conducted isometric finger extensions and flexions at 20 and 40% of maximal voluntary contractions. Electroencephalogram (EEG) data were recorded from the sensorimotor area and EMG signals were captured from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI), and biceps brachii (BIC) to investigate the CMCoh peak values in the Beta band. EMG parameters, i.e., the EMG activation level and co-contraction index (CI), were analyzed to evaluate the compensatory muscular patterns in the upper limb.Result: The peak CMCoh with statistical significance (P < 0.05) was found shifted from the ipsilesional side to the contralesional side in the proximal UE muscles, while to the central regions in the distal UE muscle in chronic strokes. Significant differences (P < 0.05) were observed in both peak ED and FD CMCohs during finger extensions between the two groups. The unimpaired controls exhibited significant intragroup differences between 20 and 40% levels in extensions for peak ED and FD CMCohs (P < 0.05). The stroke subjects showed significant differences in peak TRI and BIC CMCohs (P < 0.01). No significant inter- or intra-group difference was observed in peak CMCoh during finger flexions. EMG parameters showed higher EMG activation levels in TRI and BIC muscles (P < 0.05), and higher CI values in the muscle pairs involving TRI and BIC during all the extension and flexion tasks in the stroke group than those in the control group (P < 0.05).Conclusion: The post-stroke proximal muscular compensations from the elbow to the finger movements were cortically originated, with the center mainly located in the contralesional hemisphere.
Highlights
Post-stroke motor recovery is usually associated with the cortical reorganization and adaptive learning experiences [1]
In our previous study [6, 7], we found that the dyscoordination observed following chronic stroke was evident during distal upper extremity (UE) joint motion tasks, and that stroke patients frequently relied on compensatory contractions from proximal UE muscles to substitute for a loss or reduction in hand function
In the finger flexion movements of the current study, we found that the peak triceps brachii (TRI) and BIC corticomuscular coherence (CMCoh) shifted from the ipsilesional side to the contralesional side in chronic stroke patients, similar to the patterns observed in their finger extension exercise (Figure 2)
Summary
Post-stroke motor recovery is usually associated with the cortical reorganization and adaptive learning experiences [1]. Jones concluded that proximal compensations can be mistaken for recovery and constrain the potential motor restoration at the distal segments, leading to “learned non-use” or “learned dis-use” [8]. Such post-stroke behavioral deviation can further exacerbate motor impairments, the interaction between the cortical plasticity in chronic stroke and the dynamic muscular coordination in the upper limb has not yet been well-investigated. Proximal compensation to the distal movements is commonly observed in the affected upper extremity (UE) of patients with chronic stroke. Corticomuscular coherence (CMCoh) and electromyography (EMG) analysis were adopted to investigate the corticomuscular coordinating pattern of proximal UE compensatory activities when conducting distal UE movements in chronic stroke
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