Visual feedback during pedaling allows individuals poststroke to alter inappropriately prolonged paretic vastus medialis activity

Abstract

Individuals who have experienced a stroke often demonstrate inappropriate muscle activity phasing in the paretic leg during locomotion. Past research has demonstrated that inappropriate paretic phasing varies between behavioral contexts and is reduced during unilateral pedaling with the nonparetic leg inactive. We investigated whether individuals could voluntarily alter activity in a target muscle of the paretic limb in a consistent behavioral context and whether this voluntary change differed between bilateral and unilateral pedaling. During a fixed-speed motorized pedaling task, participants were asked to use visual feedback to deactivate the vastus medialis (VM) before a 90° target region of the pedaling cycle, as measured by surface electromyography and by change in fraction of total cycle amplitude in the target region. We based the start of this target region on the earliest observed deactivation for this muscle (found in fast pedaling), which allowed us to challenge both the paretic and nonparetic VM. During visual feedback, participants significantly reduced the fraction of activity found in the target region, with no significant difference in degree of reduction between paretic and nonparetic legs or between bilateral and unilateral pedaling. Surprisingly, in bilateral pedaling, individuals with greater clinical impairment demonstrated greater paretic limb response to feedback. Our results demonstrated that during this tightly constrained task, the paretic VM showed a surprisingly similar flexibility of muscle activity to the nonparetic VM. Our findings show that participants were able to use provided visual feedback to modulate the degree of an observed poststroke muscle-phasing impairment.NEW & NOTEWORTHY This study demonstrates that by using visual feedback during a constrained task with minimized kinematic control requirements, participants with poststroke hemiplegia can voluntarily change muscle activity phase in the vastus medialis. Surprisingly, we did not observe a significant difference in ability to alter phasing between paretic and nonparetic legs or between bilateral and unilateral pedaling. In this visual feedback task, participants appear to modify muscle activity well in both the paretic and nonparetic legs.