Evidence of synergy coordination patterns of upper-limb motor control in stroke patients with mild and moderate impairment

Abstract

Objectives: Previous studies showed that the central nervous system (CNS) controls movements by recruiting a low-dimensional set of modules, usually referred to as muscle synergies. Stroke alters the structure and recruitment patterns of muscle synergies, leading to abnormal motor performances. Some studies have shown that muscle synergies can be used as biomarkers for assessing motor function. However, coordination patterns of muscle synergies in post-stroke patients need more investigation to characterize how they are modified in functional movements. Methods: Thirteen mild-to-moderate stroke patients and twenty age-matched healthy subjects were recruited to perform two upper-limb movements, hand-to-mouth movement and reaching movement. Muscle synergies were extracted with nonnegative matrix factorization. We identified a set of reference synergies (i.e., averaged across healthy subjects) and typical synergies (i.e., averaged across stroke subjects) from the healthy group and stroke group respectively, and extracted affected synergies from each patient. Synergy similarity between groups was computed and analyzed. Synergy reconstruction analysis was performed to verify synergy coordination patterns in post-stroke patients. Results: On average, three synergies were extracted from both the healthy and stroke groups, while the mild impairment group had a significantly higher number of synergies than the healthy group. The similarity analysis showed that synergy structure was more consistent in the healthy group, and stroke instead altered synergy structure and induced more variability. Synergy reconstruction analysis at group and individual levels showed that muscle synergies of patients often showed a combination of healthy reference synergies in the analyzed movements. Finally, this study associated four synergy coordination patterns with patients: merging (equilibrium and disequilibrium), sharing (equilibrium and disequilibrium), losing, and preservation. The preservation was mainly represented in the mild impairment group, and the moderate impairment group showed more merging and sharing. Conclusion: This study concludes that stroke shows more synergy variability compared to the healthy group and the alterations of muscle synergies can be described as a combination of reference synergies by four synergy coordination patterns. These findings deepen the understanding of the underlying neurophysiological mechanisms and possible motor control strategies adopted by the CNS in post-stroke patients.

Keywords: electromyography (EMG); muscle synergies; rehabilitation; stroke; synergic patterns; upper-limb.