Impaired posture, movement preparation, and execution during both paretic and nonparetic reaching following stroke

• Published in: Journal of neurophysiology Vol. 121; no. 4; pp. 1465 - 1477
• Main Authors: Yang, Chieh-ling, Creath, Robert A., Magder, Laurence, Rogers, Mark W., McCombe Waller, Sandy
• Format: Journal Article
• Language: English
• Published: United States American Physiological Society 01.04.2019
• Series: Nervous System Pathophysiology
• Subjects: Aged; Anticipation, Psychological; Arm - physiology; Biomechanical Phenomena; Cues; Female; Goals; Humans; Male; Middle Aged; Movement; Paresis - etiology; Paresis - physiopathology; Posture; Psychomotor Performance; Stroke - complications; Stroke - physiopathology; postural control; StartReact; motor preparation; stroke; reach
• DOI: 10.1152/jn.00694.2018
• ISSN: 0022-3077; 1522-1598

Posture and movement planning, preparation, and execution of a goal-directed reaching movement are impaired in individuals with stroke. No studies have shown whether the deficits are generally impaired or are specific to the lesioned hemisphere/paretic arm. This study utilized StartReact (SR) responses elicited by loud acoustic stimuli (LAS) to investigate the preparation and execution of anticipatory postural adjustments (APAs) and reach movement response during both paretic and nonparetic arm reaching in individuals with stroke and in age-matched healthy controls. Subjects were asked to get ready after receiving a warning cue and to reach at a “go” cue. An LAS was delivered at –500, –200, and 0 ms relative to the go cue. Kinetic, kinematic, and electromyographic data were recorded to characterize APA-reach movement responses. Individuals with stroke demonstrated systemwide deficits in posture and in movement planning, preparation, and execution of APA-reach sequence as shown by significant reduction in the incidence of SR response and impaired APA-reach performance, with greater deficits during paretic arm reaching. Use of trunk compensation strategy as characterized by greater involvement of trunk and pelvic rotation was utilized by individuals with stroke during paretic arm reaching compared with nonparetic arm reaching and healthy controls. Our findings have implications for upper extremity and postural control, suggesting that intervention should include training not only for the paretic arm but also for the nonparetic arm with simultaneous postural control requirements to improve the coordination of the APA-reach performance and subsequently reduce instability while functional tasks are performed during standing. NEW & NOTEWORTHY Our study is the first to show that nonparetic arm reaching also demonstrates impairment in posture and movement planning, preparation, and execution when performed during standing by individuals with stroke. In addition, we found compensatory trunk and pelvic rotations were used during a standing reach task for the paretic arms. The findings have clinical implications for upper extremity and postural rehabilitation, suggesting that training should include the nonparetic arms and incorporate simultaneous postural control demands.