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J Neurophysiol (June 6, 2007). doi:10.1152/jn.01295.2006
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Submitted on December 11, 2006
Accepted on June 5, 2007

Changing motor synergies in chronic stroke

Laura Dipietro1*, Hermano I. Krebs2, Susan E. Fasoli3, Bruce T. Volpe4, Joel Stein5, Chris T Bever6, and Neville Hogan7

1 Mechanical Engineering, MIT, Cambridge, Massachusetts, United States
2 Mechanical Engineering, MIT, Cambridge, Massachusetts, United States; Neurology and Neuroscience, Weill Medical College of Cornell University, Burke Medical Research Institute, White Plains, New York, United States; Rehabilitation Research and Development, VA Maryland Healthcare System, Maryland, United States
3 Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, Massachusetts, United States; Mechanical Engineering, MIT, Cambridge, Massachusetts, United States
4 Neurology and Neuroscience, Weill Medical College of Cornell University, Burke Medical Research Institute, White Plains, New York, United States; Mechanical Engineering, MIT, Cambridge, Massachusetts, United States
5 Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, Massachusetts, United States
6 Rehabilitation Research and Development, VA Maryland Healthcare System, Baltimore, Maryland, United States
7 Mechanical Engineering and Brain & Cognitive Sci., MIT, Cambridge, Massachusetts, United States

* To whom correspondence should be addressed. E-mail: lauradp{at}mit.edu.

Synergies are thought to be the building blocks of vertebrate movements. The inability to execute synergies in properly timed and graded fashion precludes adequate functional motor performance. In humans with stroke, abnormal synergies are a sign of persistent neurological deficit and result in loss of independent joint control, which disrupts the kinematics of voluntary movements. This study aimed at characterizing training-related changes in synergies apparent from movement kinematics, and specifically at assessing: 1) the extent to which they characterize recovery, and 2) whether they follow a pattern of augmentation of existing abnormal synergies, or conversely, are characterized by a process of extinction of the abnormal synergies. We used a robotic therapy device to train and analyze paretic arm movements of 117 persons with chronic stroke. In a task for which they received no training, subjects were better able to draw circles by discharge. Comparison with performance at admission on kinematic robot-derived metrics showed that subjects were able to execute shoulder and elbow joint movements with significantly greater independence, or using the clinical description, with more isolated control. We argue that the changes we observed in the proposed metrics reflect changes in synergies. We show that they capture a significant portion of the recovery process, as measured by the clinical Fugl-Meyer scale. A process of ''tuning'' or augmentation of existing abnormal synergies, not extinction of the abnormal synergies, appears to underlie recovery.







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