Involuntary paretic wrist/finger flexion forces and EMG increase with shoulder abduction load in individuals with chronic stroke

ObjectiveClinical observations of the flexion synergy in individuals with chronic hemiparetic stroke describe coupling of shoulder, elbow, wrist, and finger joints. Yet, experimental quantification of the synergy within a shoulder abduction (SABD) loading paradigm has focused only on shoulder and elbow joints. The paretic wrist and fingers have typically been studied in isolation. Therefore, this study quantified involuntary behavior of paretic wrist and fingers during concurrent activation of shoulder and elbow.MethodsEight individuals with chronic moderate-to-severe hemiparesis and four controls participated. Isometric wrist/finger and thumb flexion forces and wrist/finger flexor and extensor electromyograms (EMG) were measured at two positions when lifting the arm: in front of the torso and at maximal reaching distance. The task was completed in the ACT3D robotic device with six SABD loads by paretic, non-paretic, and control limbs.ResultsConsiderable forces and EMG were generated during lifting of the paretic arm only, and they progressively increased with SABD load. Additionally, the forces were greater at the maximal reach position than at the position front of the torso.ConclusionsFlexion of paretic wrist and fingers is involuntarily coupled with certain shoulder and elbow movements.SignificanceActivation of the proximal upper limb must be considered when seeking to understand, rehabilitate, or develop devices to assist the paretic hand.

► For the first time, the paretic wrist and fingers of individuals with chronic hemiparetic stroke were investigated within the context of the upper extremity flexion synergy instead of in isolation.
► Involuntary paretic wrist and finger flexion forces and EMG were generated in proportion to descending motor drive requirements, modulated in this study by six levels of shoulder abduction torque and by forward reaching.
► Results support the hypothesis of an increased influence of bulbospinal motor pathways following stroke and suggest that activation of the proximal upper limb must be considered when seeking to understand, rehabilitate, or develop devices to assist the paretic hand.