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Modification of Spastic Stretch Reflexes at the Elbow by Flexion Synergy Expression in Individuals With Chronic Hemiparetic Stroke

  • Jacob G. McPherson
    Affiliations
    Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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  • Arno H. Stienen
    Affiliations
    Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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  • Justin M. Drogos
    Affiliations
    Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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  • Julius P. Dewald
    Correspondence
    Corresponding author Julius P. Dewald, PT, PhD, Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N Michigan Ave, Ste 1100, Chicago, IL 60611.
    Affiliations
    Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL

    Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL

    Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Chicago, IL
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      Abstract

      Objective

      To systematically characterize the effect of flexion synergy expression on the manifestation of elbow flexor stretch reflexes poststroke, and to relate these findings to elbow flexor stretch reflexes in individuals without neurologic injury.

      Design

      Controlled cohort study.

      Setting

      Academic medical center.

      Participants

      Participants (N=20) included individuals with chronic hemiparetic stroke (n=10) and a convenience sample of individuals without neurologic or musculoskeletal injury (n=10).

      Interventions

      Participants with stroke were interfaced with a robotic device that precisely manipulated flexion synergy expression (by regulating shoulder abduction loading) while delivering controlled elbow extension perturbations over a wide range of velocities. This device was also used to elicit elbow flexor stretch reflexes during volitional elbow flexor activation, both in the cohort of individuals with stroke and in a control cohort. In both cases, the amplitude of volitional elbow flexor preactivation was matched to that generated involuntarily during flexion synergy expression.

      Main Outcome Measures

      The amplitude of short- and long-latency stretch reflexes in the biceps brachii, assessed by electromyography, and expressed as a function of background muscle activation and stretch velocity.

      Results

      Increased shoulder abduction loading potentiated elbow flexor stretch reflexes via flexion synergy expression in the paretic arm. Compared with stretch reflexes in individuals without neurologic injury, paretic reflexes were larger at rest but were approximately equal to control muscles at matched levels of preactivation.

      Conclusions

      Because flexion synergy expression modifies stretch reflexes in involved muscles, interventions that reduce flexion synergy expression may confer the added benefit of reducing spasticity during functional use of the arm.

      Keywords

      List of abbreviations:

      BIC (biceps), EE (elbow extension), EF (elbow flexion), LLR (long-latency reflex), MVT (maximum voluntary torque), SABD (shoulder abduction), SLR (short-latency reflex)
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