Perturbation-induced electromyographic activity is predictive of flexion synergy expression and a sensitive measure of post-stroke motor impairment

The goal of this study was to explore whether the stretch reflex-induced muscle activity is correlated with the expression of the flexion synergy and, therefore, can serve as a quantitative indicator of post-stroke motor impairment. Eleven stroke participants stroke were recruited for this study. Their forearm was connected to a robotic device that applied continuous position perturbations to the paretic elbow joint. The magnitude of EMG activity of the spastic biceps brachii was measured. The expression of the flexion synergy was determined using the increase of synergistic elbow flexion torque when subjects were gradually lifting their paretic arm with two derived measures: normalized flexion synergy area (NFSA) and the mean slope of the expression of flexion synergy (ΔFS). Significant positive correlations were found between spastic biceps EMG (predictor variable) and the flexion synergy expression (response variables), i.e., NFSA (ρ = 0.89, p < 0.001) and ΔFS (ρ = 0.73, p = 0.01). This result indicates that the perturbation-induced EMG activity can serve as a sensitive indicator of post-stroke motor impairments related to the expression of spasticity and flexion synergy and demonstrates that these motor impairments may be mechanistically linked.