Visual feedback during pedaling allows individuals poststroke to alter inappropriately prolonged paretic vastus medialis activity

Individuals who have experienced a stroke often demonstrate inappropriate muscle activity phasing in the paretic leg during locomotion. Past research has demonstrated that inappropriate paretic phasing varies between behavioral contexts and is reduced during unilateral pedaling with the nonparetic leg inactive. We investigated whether individuals could voluntarily alter activity in a target muscle of the paretic limb in a consistent behavioral context and whether this voluntary change differed between bilateral and unilateral pedaling. During a fixed-speed motorized pedaling task, participants were asked to use visual feedback to deactivate the vastus medialis (VM) before a 90° target region of the pedaling cycle, as measured by surface electromyography and by change in fraction of total cycle amplitude in the target region. We based the start of this target region on the earliest observed deactivation for this muscle (found in fast pedaling), which allowed us to challenge both the paretic and nonparetic VM. During visual feedback, participants significantly reduced the fraction of activity found in the target region, with no significant difference in degree of reduction between paretic and nonparetic legs or between bilateral and unilateral pedaling. Surprisingly, in bilateral pedaling, individuals with greater clinical impairment demonstrated greater paretic limb response to feedback. Our results demonstrated that during this tightly constrained task, the paretic VM showed a surprisingly similar flexibility of muscle activity to the nonparetic VM. Our findings show that participants were able to use provided visual feedback to modulate the degree of an observed poststroke muscle-phasing impairment.NEW & NOTEWORTHY This study demonstrates that by using visual feedback during a constrained task with minimized kinematic control requirements, participants with poststroke hemiplegia can voluntarily change muscle activity phase in the vastus medialis. Surprisingly, we did not observe a significant difference in ability to alter phasing between paretic and nonparetic legs or between bilateral and unilateral pedaling. In this visual feedback task, participants appear to modify muscle activity well in both the paretic and nonparetic legs.

Impaired muscle phasing systematically adapts to varied relative angular relationships during locomotion in people poststroke

After stroke, hemiparesis will result in impairments to locomotor control. Specifically, muscle coordination deficits, in the form of inappropriately phased muscle-activity patterns, occur in both the paretic and nonparetic limbs. These dysfunctional paretic muscle-coordination patterns can adapt to somatosensory inputs, and also the sensorimotor state of nonparetic limb can influence paretic limb. However, the relative contribution of interlimb pathways for improving paretic muscle-activation patterns in terms of phasing remains unknown. In this study, we investigated whether the paretic muscle-activity phasing can be influenced by the relative angular-spatial relationship of the nonparetic limb by using a split-crank ergometer, where the cranks could be decoupled. Eighteen participants with chronic stroke were asked to pedal bilaterally during each task while surface electromyogram signals were recorded bilaterally from four lower extremity muscles (vastus medialis, rectus femoris, tibialis anterior, and soleus). During each experiment, the relative angular crank positions were manipulated by increasing or decreasing their difference by randomly ordered increments of 30° over the complete cycle [0° (in phase pedaling), 30°, 60°, 90°, 120°, 150°, 180° (standard pedaling), 210°, 240°, 270°, 300°, 330° (out of phase pedaling)]. We found that the paretic and nonparetic muscle phasing in the cycle systematically adapted to varied relative angular relationships, and this systematic relationship was well modeled by a sinusoidal relationship. Also, the paretic uniarticular muscle (vastus medialis) showed larger phase shifts compared with biarticular muscle (rectus femoris). More importantly, for each stroke subject, we demonstrated an exclusive crank-angular relation that resulted in the generation of more appropriately phased paretic muscle activity. These findings provide new evidence to better understand the capability of impaired nervous system to produce a more normalized muscle-phasing pattern poststroke.

Bilateral Limb Phase Relationship and Its Potential to Alter Muscle Activity Phasing During Locomotion

It is well established that the sensorimotor state of one limb can influence another limb and therefore bilateral somatosensory inputs make an important contribution to interlimb coordination patterns. However, the relative contribution of interlimb pathways for modifying muscle activation patterns in terms of phasing is less clear. Here we studied adaptation of muscle activity phasing to the relative angular positions of limbs using a split-crank ergometer, where the cranks could be decoupled to allow different spatial angular position relationships. Twenty neurologically healthy individuals performed the specified pedaling tasks at different relative angular positions while surface electromyographic (EMG) signals were recorded bilaterally from eight lower extremity muscles. During each experiment, the relative angular crank positions were altered by increasing or decreasing their difference by randomly ordered increments of 30° over the complete cycle [0° (in phase pedaling); 30, 60, 90, 120, 150, and 180° (standard pedaling); and 210, 240, 270, 300, and 330° out of phase pedaling]. We found that manipulating the relative angular positions of limbs in a pedaling task caused muscle activity phasing changes that were either delayed or advanced, dependent on the relative spatial position of the two cranks and this relationship is well-explained by a sine curve. Further, we observed that the magnitude of phasing changes in biarticular muscles (like rectus femoris) was significantly greater than those of uniarticular muscles (like vastus medialis). These results are important because they provide new evidence that muscle phasing can be systematically influenced by interlimb pathways.

Direction-Dependent Phasing of Locomotor Muscle Activity Is Altered Post-Stroke

A major contributor to impaired locomotion post-stroke is abnormal phasing of muscle activity. While inappropriate paretic muscle phasing adapts to changing body orientation, load, and speed, it remains unclear whether paretic muscle phasing adapts to reversal of locomotor direction. We examined muscle phasing in backward pedaling, a task that requires shifts in biarticular but not uniarticular muscle phasing relative to forward pedaling. We hypothesized that if paretic and neurologically intact muscle phasing adapt similarly, then paretic biarticular but not paretic uniarticular muscles would shift phasing in backward pedaling. Paretic and neurologically intact individuals pedaled forward and backward while recording electromyograms (EMGs) from vastus medialis (VM), soleus (SOL), rectus femoris (RF), semimembranosus (SM), and biceps femoris (BF). Changes in muscle phasing were assessed by comparing the probability of muscle activity in forward and backward pedaling throughout 18 pedaling cycles. Paretic uniarticular muscles (VM and SOL) showed phase-advanced activity in backward versus forward pedaling, whereas the corresponding neurologically intact muscles showed little to no phasing change. Paretic biarticular muscles were less likely than neurologically intact biarticular muscles to display phasing changes in backward pedaling. Paretic RF displayed no phase change during backward pedaling, and paretic BF displayed no consistent adaptation to backward pedaling. Paretic SM was the only muscle to display backward/forward phase changes that were similar to the neurologically intact group. We conclude that paretic uniarticular muscles are more susceptible and paretic biarticular muscles are less susceptible to direction-dependent phase shifts, consistent with altered sensory integration and impaired cortical control of locomotion.