Muscle activity adapts to anti-gravity posture during pedalling in persons with post-stroke hemiplegia

With hemiplegia following stroke, a person's movement response to anti-gravity posture often appears rigid and inflexible, exacerbating the motor dysfunction. A major determinant of pathological movement in anti-gravity postures is the failure to adapt muscle-activity patterns automatically to changes in posture. The aim of the present study was to determine whether the impaired motor performance observed when persons with hemiplegia pedal in a horizontal position is exacerbated at more vertical anti-gravity body orientations. Twelve healthy elderly subjects and 17 subjects with chronic (> 6 months) post-stroke hemiplegia participated in the study. Subjects pedalled a modified ergometer at different body orientations (from horizontal to vertical), maintaining the same workload, cadence, and hip and knee kinematics. Pedal reaction forces, and crank and pedal kinematics, were measured and then used to calculate the work done by each leg and their net positive and negative components. The EMG was recorded from four leg muscles (tibialis anterior, medial gastrocnemius, rectus femoris and biceps femoris). The main result from this study was that impaired plegic leg performance, as measured by net negative work done by the plegic leg and abnormal early rectus femoris activity, was exacerbated at the most vertical body orientations. However, contrary to the belief that muscle activity cannot adapt to anti-gravity postures, net positive work increased appropriately and EMG activity in all muscles showed modulated levels of activity similar to those in elderly control subjects. These results support the hypothesis that increased verticality exacerbates the already impaired movement performance. Yet, much of the motor response to verticality was flexible and appropriate, given the mechanics of the task.