Influence of task complexity on movement planning and release after stroke: insights from startReact

The capacity to plan movement following stroke is diminished when reaching from a standing position. Two mechanisms have been proposed: increased task complexity compared to simpler tasks and inhibition between the pathways controlling whole-body posture and upper extremity reaching. The objective of this study was to determine if task complexity alone can alter planning and release (or involuntary execution) capacity when whole-body postural adjustment is not required. Data were collected from 10 stroke survivors and 8 age-matched controls. Ballistic elbow extension movements were performed with and without voluntary shoulder abduction, adding complexity by anti-gravity arm support that enhanced the expression of abnormal muscle synergies linking elbow and shoulder after stroke. Our primary finding was in support of our hypothesis that startReact (involuntary release of planned movement by a startling stimulus) would be intact but that the increased task complexity would decrease the capacity to plan and release movement. StartReact was intact for both tasks with and without shoulder abduction. Despite the intact startReact response across both conditions following stroke, the incidence of startReact was decreased during the shoulder abduction task similar to prior studies showing a decrease during tasks of higher complexity. Our results suggest that individuals with stroke have a diminished capacity to plan and release movement as task complexity increases. This study highlights the unique potential for startReact to be used as a clinical tool to probe the capacity to plan and release movement following stroke and how that capacity is affected by the complexity of the task being performed. Such a tool may be useful for assessing functional impairments and tracking changes during the rehabilitation process.