Corticospinal tract integrity correlates with knee extensor weakness in chronic stroke survivors

ObjectiveMuscle weakness develops rapidly after stroke, adversely affecting motor performance, and contributing to reduced functional ability. While the contributions of structural and functional alterations in skeletal muscle to post-stroke weakness have been well described, the relationship between motor pathway integrity, measured using both radiological and electrophysiological techniques, and post-stroke muscle weakness is not clear. This study sought to determine the role of corticospinal tract (CST) integrity on knee extensor weakness in chronic stroke survivors.MethodsKnee extensor strength and activation testing were performed at 90° of knee flexion using an interpolated triplet technique. CST integrity was evaluated using data obtained from Diffusion Tensor Imaging and transcranial magnetic stimulation.ResultsRecordings in nine stroke subjects indicated substantial knee extensor weakness and activation deficits in the paretic legs of the stroke survivors. Regression analysis revealed that asymmetry in CST integrity was strongly related to between-leg differences in knee strength.ConclusionsThe results of this study suggest a strong link between CST integrity and lower extremity strength, and add to the growing evidence of substantial knee extensor weakness and activation impairments in stroke survivors.SignificanceThe findings from this study further our understanding of the anatomical and neurophysiological contributions to motor impairments after stroke, which may benefit clinicians and researchers in the field of stroke rehabilitation.

► We assessed corticospinal tract integrity and muscle weakness in stroke patients.
► Profound quadriceps weakness and activation deficits were observed.
► Knee extensor weakness was strongly related to motor pathway integrity.
► Neural impairment of the non-paretic leg was evident many years after stroke.