Differences between flexion and extension synergy-driven coupling at the elbow,wrist, and fingers of individuals with chronic hemiparetic stroke |
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Authors: | Laura Miller McPherson Julius P.A. Dewald |
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Affiliation: | 1. Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;2. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA;3. Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA;4. Department of Biomedical Engineering, College of Engineering and Computing, Florida International University, Miami, FL, USA;5. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA |
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Abstract: | ObjectiveThe flexion and extension synergies were quantified at the paretic elbow, forearm, wrist, and finger joints within the same group of participants for the first time. Differences in synergy expression at each of the four joints were examined, as were the ways these differences varied across the joints.MethodsTwelve post-stroke individuals with chronic moderate-to-severe hemiparesis and six age-matched controls participated. Participants generated isometric shoulder abduction (SABD) and shoulder adduction (SADD) at four submaximal levels to progressively elicit the flexion and extension synergies, respectively. Isometric joint torques and EMG were recorded from shoulder, elbow, forearm (radio-ulnar), wrist, and finger joints and muscles.ResultsSABD elicited strong wrist and finger flexion torque that increased with shoulder torque level. SADD produced primarily wrist and finger flexion torque, but magnitudes at the wrist were less than during SABD. Findings contrasted with those at the elbow and forearm, where torques and EMG generated due to SABD and SADD were opposite in direction.ConclusionsFlexion and extension synergy expression are more similar at the hand than at the shoulder and elbow. Specific bulbospinal pathways that may underlie flexion and extension synergy expression are discussed.SignificanceWhole-limb behavior must be considered when examining paretic hand function in moderately-to-severely impaired individuals. |
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Keywords: | Corresponding author at: 645 N. Michigan Ave, Suite 1100, Chicago, IL 60611, USA. Fax: +1 312 908 0741. Stroke Upper extremity Flexion synergy Extension synergy Hand Rehabilitation Reticulospinal Vestibulospinal Bulbospinal SABD shoulder abduction SADD shoulder adduction EMG electromyography FCR flexor carpi radialis FDP flexor digitorum profundus FDI first dorsal interosseous ECR extensor carpi radialis EDC extensor digitorum communis FPB flexor pollicis brevis EPL extensor pollicis longus FMA upper extremity Fugl-Meyer Motor Assessment CMSAh hand portion of the Chedoke-McMaster Stroke Assessment WFTS Wrist and Finger Torque Sensor BG Basal Ganglia TH Thalamus IC Internal Capsule CFL Cortical Frontal Lobe SFL Subcortical Frontal Lobe CPL Cortical Parietal Lobe CTL Cortical Temporal Lobe HC Hippocampus IN Insula N/A Not Available |
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