Alterations in the preferred direction of individual arm muscle activation after stroke

INTRODUCTION: Stroke survivors have challenges appropriately coordinating the multiple muscles, resulting in a deficit in motor control. Therefore, comprehending the mechanism underlying abnormal intermuscular coordination becomes crucial in developing effective rehabilitation strategies. Quantitative analyses have been employed at pairwise or multi-dimensional levels to understand the underlying mechanism of abnormal intermuscular coordination and its relationship to motor impairment. However, how alterations in individual muscle activation contribute to abnormal intermuscular coordination, motor impairment, and motor performance remains unclear. Thus, we investigated the alterations in the preferred direction of individual muscles after stroke and their relationship with stroke-induced changes in intermuscular coordination, clinical motor impairment, and qualities of motor performance during isometric force generation in the upper extremity. METHODS: Twenty-four stroke survivors and six age-matched controls were recruited and performed isometric force target matches while recording electromyographic signals from eight upper limb muscles. We determined the preferred activation direction of each muscle, evaluated abnormal intermuscular coordination through a muscle synergy analysis, assessed motor impairment using upper extremity Fugl-Meyer Assessment scores, and examined motor performance characteristics defined by force trajectory features. RESULTS: The post-stroke alterations in the preferred direction of the brachioradialis, anterior, middle, and posterior deltoid were correlated with the motor impairment level and attributed to the changes in muscle synergy characteristics. Only alterations in the preferred direction of the brachioradialis and posterior deltoid activation in forward-backward and upward-downward axes were associated with the qualities of isometric force generation, respectively. DISCUSSION: These findings imply that alterations in the preferred direction of individual muscle activation contribute to various aspects of motor deficit following stroke. This insight may serve as a foundation for the development of innovative stroke neurorehabilitation approaches that take into account specific attributes of individual muscle activation, including their preferred activation direction.