Contralateral Motor Overflow Research Articles

Motor Overflow and Spasticity in Chronic Stroke Share a Common Pathophysiological Process: Analysis of Within-Limb and Between-Limb EMG-EMG Coherence

The phenomenon of exaggerated motor overflow is well documented in stroke survivors with spasticity. However, the mechanism underlying the abnormal motor overflow remains unclear. In this study, we aimed to investigate the possible mechanisms behind abnormal motor overflow and its possible relations with post-stroke spasticity. 11 stroke patients (63.6 ± 6.4 yrs; 4 women) and 11 healthy subjects (31.18 ± 6.18 yrs; 2 women) were recruited. All of them were asked to perform unilateral isometric elbow flexion at submaximal levels (10, 30, and 60% of maximum voluntary contraction). Electromyogram (EMG) was measured from the contracting biceps (iBiceps) muscle and resting contralateral biceps (cBiceps), ipsilateral flexor digitorum superficialis (iFDS), and contralateral FDS (cFDS) muscles. Motor overflow was quantified as the normalized EMG of the resting muscles. The severity of motor impairment was quantified through reflex torque (spasticity) and weakness. EMG-EMG coherence was calculated between the contracting muscle and each of the resting muscles. During elbow flexion on the impaired side, stroke subjects exhibited significant higher motor overflow to the iFDS muscle compared with healthy subjects (ipsilateral or intralimb motor overflow). Stroke subjects exhibited significantly higher motor overflow to the contralateral spastic muscles (cBiceps and cFDS) during elbow flexion on the non-impaired side (contralateral or interlimb motor overflow), compared with healthy subjects. Moreover, there was significantly high EMG-EMG coherence in the alpha band (6–12 Hz) between the contracting muscle and all other resting muscles during elbow flexion on the non-impaired side. Our results of diffuse ipsilateral and contralateral motor overflow with EMG-EMG coherence in the alpha band suggest subcortical origins of motor overflow. Furthermore, correlation between contralateral motor overflow to contralateral spastic elbow and finger flexors and their spasticity was consistently at moderate to high levels. A high correlation suggests that diffuse motor overflow to the impaired side and spasticity likely share a common pathophysiological process. Possible mechanisms are discussed.

Motor overflow in spastic hemiplegia after stroke

The phenomenon of exaggerated motor overflow (involuntary movements accompanying a motor task) is well documented, particularly in stroke survivors with spasticity. In this study, we aimed to investigate the possible underlying mechanisms its possible relations with post-stroke spasticity. Eleven stroke patients (63.6 yrs ± 6.4 yrs; 4 women) and 11 healthy subjects (age: 31.18 yrs ± 6.18 yrs; 2 women) were recruited and performed unilateral isometric elbow flexion at submaximal levels (10%, 30%, and 60% of maximum voluntary contraction, MVC). Electromyograms (EMG) was measured from the contracting biceps muscle and resting contralateral biceps, ipsilateral flexor digitorum superficialis, and contralateral FDS muscles. Motor overflow was quantified as the normalized EMG of the resting muscles. EMG-EMG coherence was calculated between the contracting muscle and each of the resting muscle. Elbow flexor spasticity was quantified through reflex torque. Overall, our results demonstrated that unilateral elbow flexion caused diffuse motor overflow from proximal to distal muscles on the impaired side (ipsilateral motor overflow) and from the non-impaired side to the impaired side (contralateral motor overflow). Moreover, there were significantly high EMG-EMG coherence between 6–12 Hz between the contracting muscle and all other resting muscles during elbow flexion on the non-impaired side. Our results of diffuse ipsilateral and contralateral motor overflow with EMG-EMG coherence in the alpha band suggest subcortical origins of motor overflow. Post-stroke spasticity is attributed to reticulospinal hyperexcitability secondary to the unmasking of ponto-medullary reticular formation. A high correlation between spasticity and motor overflow supports a potential role of reticulospinal activation in motor overflow. Collectively, these results suggest that diffuse motor overflow to the impaired side is likely related to activation of hyperexcitable reticulospinal pathways after stroke.

T54. The difference of contralateral motor overflow according to spasticity among people with stroke

Introduction Contralateral motor overflow is known as overt involuntary movement from accompanied contralateral production of voluntary movement. The prevalence of motor overflow is high in patients with stroke. Many previous studies were reported, however there is lack of studies about the relationship between motor overflow and spasticity or musculoskeletal factor. The objective of the present study was to investigate the contralateral motor overflow in patients with stroke during finger force production tasks in terms of spasticity and musculoskeletal factor. Methods Forty-four patients with stroke, and 20 healthy control were participated in this study. Participants were seated and requested to put all fingers of both hands on force sensors (FUTEK) with various musculoskeletal factors (wrist posture: flexed, neutral, and extended posture) and speed (fast, slow). They produced maximum isometric pressing force with all fingers of right or left hand and the forces were recorded. We analyzed motor overflow magnitude, which is defined as the ratio of the non-task hand force to the corresponding task hand finger force. The spasticity was graded as modified Ashworth scale and we define that of healthy control as 0. Results Motor overflow was different according to spasticity and the difference was consistent regardless of wrist posture and speed (all, p Conclusion We conclude that contralateral motor overflow during maximum force production tasks is dependent on the spasticity and speed of finger flexion regardless of physical wrist posture. Therefore, contralateral motor overflow could result from upper motor neuron lesion other than musculoskeletal facots.

Cortical functioning in children with developmental coordination disorder: a motor overflow study.

This study examined brain activation in children with developmental coordination disorder (DCD) to reveal areas that may contribute to poor movement execution and/or abundant motor overflow. Using functional magnetic resonance imaging, 13 boys with DCD (mean age = 9.6 years ±0.8) and 13 typically developing controls (mean age = 9.3 years ±0.6) were scanned performing two tasks (finger sequencing and hand clenching) with their dominant hand, while a four-finger motion sensor recorded contralateral motor overflow on their non-dominant hand. Despite displaying increased motor overflow on both functional tasks during scanning, there were no obvious activation deficits in the DCD group to explain the abundant motor overflow seen. However, children with DCD were found to display decreased activation in the left superior frontal gyrus on the finger-sequencing task, an area which plays an integral role in executive and spatially oriented processing. Decreased activation was also seen in the left inferior frontal gyrus, an area typically active during the observation and imitation of hand movements. Finally, increased activation in the right postcentral gyrus was seen in children with DCD, which may reflect increased reliance on somatosensory information during the execution of complex fine motor tasks.

Difference of motor overflow depending on the impaired or unimpaired hand in stroke patients

The aim of this study was to investigate the patterns of contralateral motor overflow (i.e. mirror movement) between the homologous body parts on the right and left side, in stroke patients during single-finger and multi-finger maximum force production tasks. Forty subjects, including stroke (n=20) and normal subjects (n=20), participated in this study. The stroke subjects maximally pressed force sensors with their fingers in a flexed position using a single (index, middle, ring, or little) or all fingers (all 4 fingers) using the impaired (IH) or unimpaired (UIH) hand, while the non-patient subjects used their right hands for the same tasks. The maximal voluntary forces in the ipsilateral and unintended pressing forces of each contralateral finger were recorded during the tasks. The magnitude of motor overflow to the contralateral side was calculated using the index of contralateral independence (CI). During the single finger tasks, the finger CI was significantly decreased in the UIH (91%) compared with that in the IH (99%) or normal hands (99%). Likewise, the multiple finger tasks showed that the CI was significantly lower in the UIH (84%) compared with that in the IH (96%) or normal hands (99%). However, the maximal forces were significantly lower in the IH relative to those in the UIH and normal hands. These data demonstrate that stroke patients have greater motor overflow from the UIH to the IH.

Acoustic Startle Reflex in Patients With Chronic Stroke at Different Stages of Motor Recovery: A Pilot Study

Background: Acoustic startle reflex (ASR) can be used as a tool to examine reticulospinal excitability. The potential role of reticulospinal mechanisms in the development of spasticity has been suggested but not tested. Objective: To examine reticulospinal excitability at different stages of motor recovery in patients with chronic stroke using the ASR. Methods: Sixteen subjects with hemiplegic stroke participated in the study. We examined ASR responses at rest and contralateral motor overflow during voluntary elbow flexion. Results: ASR responses in impaired biceps muscles showed different patterns at different stages. In subjects without spasticity, ASR responses were less frequent (10% on impaired side) and had normal duration (<200 ms). In subjects with spasticity, the responses were more frequent (58.3% on impaired side) and longer lasting (up to 1 minute). However, no correlation between exaggerated reflex responses and Modified Ashworth Scale (MAS) scores was observed. During voluntary elbow flexion on the impaired side, similar positive linear force-electromyogram (EMG) relationships were found in subjects with and without spasticity. Electromyographic activity of the resting nonimpaired limb increased proportionally in subjects with spasticity (r = 0.6313, P = .0004), but no such correlation was found in subjects without spasticity (r = 0.0191, P = .9612). Conclusions: Preliminary findings of exaggerated ASR responses and associated contralateral overflow only in spastic biceps muscles in patients with chronic stroke suggest the important role of reticulospinal mechanisms in the development of spasticity.

Interlimb interactions during bilateral voluntary elbow flexion tasks in chronic hemiparetic stroke

The purpose was to systematically investigate interlimb interactions in chronic hemiparetic stroke. Fourteen poststroke hemiparetic subjects (>1 year) performed maximum voluntary contraction (MVC) elbow flexion tasks without visual feedback with one (unilateral) and two limbs simultaneously (bilateral). At submaximal levels, subjects produced force to a visual target reflecting 20%, 40%, 60%, and 80% of corresponding MVC in unilateral tasks, and of summated unilateral MVCs in bilateral tasks. Elbow flexion force and biceps surface electromyogram (EMG) were measured bilaterally. Proportionally increased EMG activity on the contralateral limb (motor overflow) was observed during unilateral tasks of the nonimpaired limb but not of the impaired limb. During bilateral tasks at submaximal levels, the impaired limb produced less force (i.e., force deficit [FD]) as compared to expected forces based upon its unilateral MVC. Force deficit on the impaired limb was compensated by greater force production on the nonimpaired limb such that the visual target was reached. However, force contribution to the total force progressively decreased from the nonimpaired side, when the level of submaximal contractions increased. During bilateral MVC tasks, there was no FD on the impaired limb, but FD was observed on the nonimpaired limb. A net result of a small bilateral deficit in force with parallel changes in EMG was observed. These novel findings of activation level–dependent interactions and asymmetrical contralateral motor overflow provide new insights that, among other compensatory mechanisms, ipsilateral corticospinal projections from the nonlesioned hemisphere play an important role in interlimb interactions in chronic stroke, in addition to unbalanced interhemispheric inhibition.

Excessive contralateral motor overflow in schizophrenia measured by fMRI

Schizophrenia is characterized by significant problems in control of behavior; however, the disturbances in neural systems that control movement remain poorly characterized. We used functional magnetic resonance imaging (fMRI) to evaluate the origin of motor overflow in schizophrenia. Twenty-seven clinically stable medicated outpatients with Diagnostic and Statistical Manual, 4th edition, text revision (DSM-IV-TR)-defined schizophrenia (SZ), and 18 healthy control (HC) subjects, all right-handed, performed a dominant-handed, single-choice visual sensorimotor reaction time paradigm during fMRI. Voxel-wise analyses were conducted within sensorimotor cortical and striatal regions on general linear model (GLM)-derived measures of blood oxygen level-dependent (BOLD) signal change. The SZ group was not different from the HC group in reaction time, activation in somatosensory or motor cortices ipsilateral to the active (intended) descending corticospinal tract, nor visual cortex. However, in the right hemisphere (contralateral to the active M1), the SZ group showed significantly higher activation in primary motor cortex and adjacent premotor and somatosensory cortices (right Brodmann areas (BA) 1 through 4, and 6), and significantly lower activation in bilateral basal ganglia. Right BA 4 activation was strongly related to disorganization and poverty symptoms (and unrelated to medications) in the patient group. This study provides evidence in SZ of excessive neural activity in motor cortex contralateral to the intended primary motor cortex, which may form the basis for altered motor laterality and motor overflow previously observed, and disorganized behavior. This pathological motor overflow may be partly due to altered modulation of intended movement within the basal ganglia and premotor cortex.

Similarity in the dynamics of contralateral motor overflow through increasing frequency of movement in a single limb

This study was designed to investigate the effects of increasing movement frequency of a single limb on the degree of similarity and coherence of the motor outflow in the non-active limb. Twelve young adults performed a series of unilateral hand-clapping tasks (horizontal and vertical in 25-s trials) while seated. Individuals began the movements at a frequency of 1Hz for 5s and were required to increase the movement frequency so as to reach their maximum movement frequency during the latter parts of the trial. Hand and finger kinematics and surface EMG of each arm were recorded. The results showed a progressive emergence of overflow muscle activity and involuntary motion in the non-active arm as the movement frequency of the unilateral action increased toward the upper frequency limits of voluntary movement. This ceiling occurred within the range of 6-7Hz. Activity in the non-active limb emerged as the movement frequency requirements increased, irrespective of the direction of motion for the task (vertical, horizontal), hand used (preferred, non-preferred) or the auditory timing stimulus provided (metronome, no-metronome). The dynamics of the motor overflow in the non-active limb exhibited time- and frequency-dependent patterns similar to those of the active arm. Together, these results demonstrate that the high-frequency unilateral movements of one limb drives the emergence of motor outflow to the opposite limb with the motor output dynamics being produced across both limbs being progressively similar as movement speed increases.

Hand digit control in children: motor overflow in multi-finger pressing force vector space during maximum voluntary force production

The aim of this study was to investigate the contralateral motor overflow in children during single-finger and multi-finger maximum force production tasks. Forty-five right handed children, 5-11 years of age produced maximum isometric pressing force in flexion or extension with single fingers or all four fingers of their right hand. The forces produced by individual fingers of the right and left hands were recorded and analyzed in four-dimensional finger force vector space. The results showed that increases in task (right) hand finger forces were linearly associated with non-task (left) hand finger forces. The ratio of the non-task hand finger force magnitude to the corresponding task hand finger force magnitude, termed motor overflow magnitude (MOM), was greater in extension than flexion. The index finger flexion task showed the smallest MOM values. The similarity between the directions of task hand and non-task hand finger force vectors in four-dimensional finger force vector space, termed motor overflow direction (MOD), was the greatest for index and smallest for little finger tasks. MOM of a four-finger task was greater than the sum of MOMs of single-finger tasks, and this phenomenon was termed motor overflow surplus. Contrary to previous studies, no single-finger or four-finger tasks showed significant changes of MOM or MOD with the age of children. We conclude that the contralateral motor overflow in children during finger maximum force production tasks is dependent upon the task fingers and the magnitude and direction of task finger forces.

Motor dysfunction in schizotypal personality disorder

Past research has revealed that schizophrenia is associated with voluntary movement abnormalities, as well as higher rates of involuntary movements. On instrumental motor tasks, patients manifest reduced motor stability, excessive force and more contralateral motor overflow (movement in the non-responding hand). In the present study, an instrumental motor task (manual response forced-choice task) was administered to a group of adults with schizotypal personality disorder (SPD) in order to determine whether they show motor deficits similar to those observed in schizophrenia. As predicted, the schizotypal subjects were excessive and more variable in motor force, compared to healthy controls and other personality-disordered subjects. Additionally, the force and variability of the motor responses were positively correlated with ratings of both positive and negative SPD symptoms. Finally, motor overflow and negative symptoms were associated with higher salivary cortisol levels. The pattern of findings is consistent with previous reports linking motor abnormalities and heightened cortisol with schizotypal personality disorder.

Effect of unimanual training on contralateral motor overflow in children and adults

Young children and adults performed a rapid unimanual finger‐lifting task. Active hand performance and ipsilateral and contralateral motor overflow were examined using a cross‐hand transfer‐of‐training paradigm. Lateral asymmetries in both the performing hands and overflow hands were investigated. An expected developmental trend was evidenced with children exhibiting more motor overflow than adults. There was also greater overflow evidenced when performing with the left hand than with the right hand in both children and adults. Children evidenced a similar asymmetry in transfer of training, that is, greater transfer of training from the left hand to the right hand than vice versa. The relationship between asymmetries in motor overflow and transfer of training is discussed in terms of cerebral specialization for movement control. Finally, training does seem to influence ipsilateral overflow, suggesting that task efficiency may play a role in the occurrence of motor overflow and that caution be exercised in...