Stroke-Related Changes in Tonic and Phasic Muscle Recruitment During Reaching Reveal Pathway-Specific Motor Deficits

Upper limb motor deficits are common after stroke and often persist despite rehabilitation. While clinical assessments emphasize movement quality, they do not capture the underlying neuromuscular impairments, particularly in individuals with mild deficits. This limits the development of individualized treatment approaches.

This study aimed to characterize stroke-related changes in muscle recruitment during reaching by separating tonic (gravity-compensating) and phasic (intersegmental dynamics-related) components of EMG activity.

Cross-sectional observational study with a comparative design.

We recorded surface EMG from 12 upper limb muscles during goal-directed reaching in 8 individuals with unilateral ischemic stroke, 5 age-matched and 9 young individuals. Using principal component analysis, we extracted tonic and phasic components and compared their amplitude, directional tuning, and coactivation patterns across groups. Group differences were evaluated with generalized linear mixed-effects models, regression, and correlation analyses.

Even individuals with mild stroke exhibited abnormal muscle recruitment. Proximal muscles were over-recruited in directions that typically require less activation, indicating altered directional tuning. Phasic activation of distal muscles was significantly reduced and worsened with time post-stroke (R² = 0.52, P = 0.002). Tonic overactivation of proximal muscles was present across all stroke participants. Muscle coactivation patterns were hemisphere-specific: right-hemisphere stroke reduced tonic coactivation in contralateral arms, whereas left-hemisphere stroke increased it. Abnormal phasic coactivation between proximal and distal muscles correlated with impaired intersegmental dynamics compensation (R² = 0.67, P = 0.013). Tonic and phasic impairments were often correlated, suggesting shared disruption of corticospinal and reticulospinal pathways.

These findings reveal distinct yet interacting deficits in tonic and phasic muscle recruitment following stroke, including persistent overactivation of proximal muscles for antigravity support and reduced phasic activation of distal muscles. These results suggest that individualized rehabilitation strategies should address both inefficient gravitational support and impaired intersegmental coordination to reduce post-stroke muscle overactivation and improve movement efficiency.