Motor Overflow and Spasticity in Chronic Stroke Share a Common Pathophysiological Process: Analysis of Within-Limb and Between-Limb EMG-EMG Coherence

Yen-Ting Chen, Shengai Li, Elaine Magat, Ping Zhou, Sheng Li, Yen-Ting Chen, Shengai Li, Elaine Magat, Ping Zhou, Sheng Li

Abstract

The phenomenon of exaggerated motor overflow is well documented in stroke survivors with spasticity. However, the mechanism underlying the abnormal motor overflow remains unclear. In this study, we aimed to investigate the possible mechanisms behind abnormal motor overflow and its possible relations with post-stroke spasticity. 11 stroke patients (63.6 ± 6.4 yrs; 4 women) and 11 healthy subjects (31.18 ± 6.18 yrs; 2 women) were recruited. All of them were asked to perform unilateral isometric elbow flexion at submaximal levels (10, 30, and 60% of maximum voluntary contraction). Electromyogram (EMG) was measured from the contracting biceps (iBiceps) muscle and resting contralateral biceps (cBiceps), ipsilateral flexor digitorum superficialis (iFDS), and contralateral FDS (cFDS) muscles. Motor overflow was quantified as the normalized EMG of the resting muscles. The severity of motor impairment was quantified through reflex torque (spasticity) and weakness. EMG-EMG coherence was calculated between the contracting muscle and each of the resting muscles. During elbow flexion on the impaired side, stroke subjects exhibited significant higher motor overflow to the iFDS muscle compared with healthy subjects (ipsilateral or intralimb motor overflow). Stroke subjects exhibited significantly higher motor overflow to the contralateral spastic muscles (cBiceps and cFDS) during elbow flexion on the non-impaired side (contralateral or interlimb motor overflow), compared with healthy subjects. Moreover, there was significantly high EMG-EMG coherence in the alpha band (6-12 Hz) between the contracting muscle and all other resting muscles during elbow flexion on the non-impaired side. Our results of diffuse ipsilateral and contralateral motor overflow with EMG-EMG coherence in the alpha band suggest subcortical origins of motor overflow. Furthermore, correlation between contralateral motor overflow to contralateral spastic elbow and finger flexors and their spasticity was consistently at moderate to high levels. A high correlation suggests that diffuse motor overflow to the impaired side and spasticity likely share a common pathophysiological process. Possible mechanisms are discussed.

Keywords: EMG-EMG coherence; motor overflow; reticulospinal tract; spasticity; stroke.

Figures

Figure 1
Figure 1
Motor overflow in a 41 year old stroke survivor with right spastic hemiplegia from a left middle cerebral artery hemorrhagic stroke. (A) standing and relaxed; (B) standing and left hand squeezing; (C) sitting and relaxed; (D) sitting and resisted hand/finger extension on the left side. Photos were recently taken from PI's spasticity clinic, a written consent of media release was signed by the patient.
Figure 2
Figure 2
Representative trials of force and EMG during a 60% MVC NDEF task of one healthy subject and 60% MVC NIPEF and IPEF tasks of one stroke subject. Note that the scale for the iBiceps is 0.5 mV and the scales for the overflow muscles (iFDS, cBicep, and cFDS) are 0.05 mV.
Figure 3
Figure 3
Muscle activity during DEF and NDEF tasks for healthy subjects and IPEF and NIPEF tasks for stroke subjects during 10, 30, and 60% of the MVC contraction task. (A) iBiceps muscle (contracting muscle) activity of stroke patients during IPEF and NIPEF tasks and the averaged iBiceps muscle activity of healthy subjects. (B) iFDS muscle activity of stroke patients during IPEF and NIPEF tasks and the averaged iFDS muscle activity of healthy subjects. (C) cBiceps muscle activity of stroke patients during IPEF and NIPEF tasks and the averaged cBiceps muscle activity of healthy subjects. (D) cFDS muscle activity of stroke patients during IPEF and NIPEF tasks and the averaged cFDS muscle activity of healthy subjects.
Figure 4
Figure 4
EMG-EMG coherence between contracting biceps and other resting muscles. Note that the ellipse highlights the significant coherence in the alpha band. Yellow boxes, red boxes, and blue boxes indicated the range of alpha band, beta band, and gamma band, respectively. Red lines indicated significant level for each figure. Coherence between (A) iBiceps and iFDS muscles in healthy subjects, (B) iBiceps and iFDS muscles during IPEF tasks in stroke patients, (C) iBiceps and iFDS muscles during NIPEF tasks in stroke patients, (D) iBiceps and cBiceps muscles in healthy subjects, (E) iBiceps and cBiceps muscles during IPEF tasks in stroke patients, (F) iBiceps and cBiceps muscles during NIPEF tasks in stroke patients, (G) iBiceps and cFDS muscles in healthy subjects, (H) iBiceps and cFDS muscles during IPEF tasks in stroke patients, and (I) iBiceps and cFDS muscles during NIPEF tasks in stroke patients.
Figure 5
Figure 5
Schematic illustration of motor overflow patterns in chronic stroke.

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