Neuro-Mechanics of Recumbent Leg Cycling in Post-Acute Stroke Patients

Cycling training is strongly applied in post-stroke rehabilitation, but how its modular control is altered soon after stroke has been not analyzed yet. EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls. Patients were asked to walk over a GaitRite mat and standard gait parameters were computed. Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs. Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index (Spearman’s coefficient = 0.521). The reduced coordination complexity resulted in a reduced biomechanical performance, with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side. These patients also exhibited locomotor impairments (reduced gait speed, asymmetrical stance time, prolonged double support time). Significant correlations were found between cycling-based metrics and gait parameters, suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions. Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke, mainly in the early phase, when patients can be unable to perform a safe and active gait training.

[1]  Jessica L. Allen,et al.  Neuromechanical Principles Underlying Movement Modularity and Their Implications for Rehabilitation , 2015, Neuron.

[2]  Steven A. Kautz,et al.  Evaluation of Abnormal Synergy Patterns Poststroke: Relationship of the Fugl-Meyer Assessment to Hemiparetic Locomotion , 2010, Neurorehabilitation and neural repair.

[3]  Zeevi Dvir,et al.  The influence of early cycling training on balance in stroke patients at the subacute stage. Results of a preliminary trial , 2006, Clinical rehabilitation.

[4]  Richard R Neptune,et al.  Coordination of Hemiparetic Locomotion after Stroke Rehabilitation , 2005, Neurorehabilitation and neural repair.

[5]  G. Davis,et al.  Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exercise–Controlled Study , 2008, Journal of the American Geriatrics Society.

[6]  G. Ferrigno,et al.  A biofeedback cycling training to improve locomotion: a case series study based on gait pattern classification of 153 chronic stroke patients , 2011, Journal of NeuroEngineering and Rehabilitation.

[7]  Stacie A. Chvatal,et al.  Decomposing Muscle Activity in Motor TasksMethods and Interpretation , 2010 .

[8]  G. Ferrigno,et al.  Cycling Induced by Electrical Stimulation Improves Muscle Activation and Symmetry During Pedaling in Hemiparetic Patients , 2012, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[9]  Seyed A Safavynia,et al.  Muscle Synergies: Implications for Clinical Evaluation and Rehabilitation of Movement. , 2011, Topics in spinal cord injury rehabilitation.

[10]  P. Lin,et al.  Biomechanical assessments of the effect of visual feedback on cycling for patients with stroke. , 2012, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[11]  Stefan Golaszewski,et al.  Functional electrical stimulation-assisted active cycling--therapeutic effects in patients with hemiparesis from 7 days to 6 months after stroke: a randomized controlled pilot study. , 2015, Archives of physical medicine and rehabilitation.

[12]  F. Zajac,et al.  Muscle coordination of maximum-speed pedaling. , 1997, Journal of biomechanics.

[13]  Simona Ferrante,et al.  Cycling, a tool for locomotor recovery after motor lesions? , 2008, NeuroRehabilitation.

[14]  Chitralakshmi K. Balasubramanian,et al.  Anterior-Posterior Ground Reaction Forces as a Measure of Paretic Leg Contribution in Hemiparetic Walking , 2006, Stroke.

[15]  Richard R Neptune,et al.  Merging of healthy motor modules predicts reduced locomotor performance and muscle coordination complexity post-stroke. , 2010, Journal of neurophysiology.

[16]  Dario Farina,et al.  Impulses of activation but not motor modules are preserved in the locomotion of subacute stroke patients. , 2011, Journal of neurophysiology.

[17]  S A Kautz,et al.  Speed-dependent reductions of force output in people with poststroke hemiparesis. , 1999, Physical therapy.

[18]  J. Chen,et al.  Kinesiological and kinematical analysis for stroke subjects with asymmetrical cycling movement patterns. , 2005, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[19]  Benjamin J. Fregly,et al.  Neuromuscular Complexity During Gait is not Responsive to Medication in Persons with Parkinson’s Disease , 2014, Annals of Biomedical Engineering.

[20]  S A Kautz,et al.  Relationships between timing of muscle excitation and impaired motor performance during cyclical lower extremity movement in post-stroke hemiplegia. , 1998, Brain : a journal of neurology.

[21]  Stefano Piazza,et al.  Shared muscle synergies in human walking and cycling. , 2014, Journal of neurophysiology.

[22]  Richard R Neptune,et al.  Modular control of human walking: a simulation study. , 2009, Journal of biomechanics.

[23]  Sylvain Dorel,et al.  Consistency of muscle synergies during pedaling across different mechanical constraints. , 2011, Journal of neurophysiology.

[24]  Silvia Conforto,et al.  Feedback of mechanical effectiveness induces adaptations in motor modules during cycling , 2013, Front. Comput. Neurosci..

[25]  G. Ferrigno,et al.  Cycling Induced by Electrical Stimulation Improves Motor Recovery in Postacute Hemiparetic Patients: A Randomized Controlled Trial , 2011, Stroke.

[26]  E. Bizzi,et al.  Article history: , 2005 .

[27]  Silvia Conforto,et al.  Inter-individual variability of forces and modular muscle coordination in cycling: a study on untrained subjects. , 2013, Human movement science.

[28]  Lena H Ting,et al.  Task-level feedback can explain temporal recruitment of spatially fixed muscle synergies throughout postural perturbations. , 2012, Journal of neurophysiology.

[29]  H. Sebastian Seung,et al.  Learning the parts of objects by non-negative matrix factorization , 1999, Nature.

[30]  S. Micera,et al.  Age-related modifications of muscle synergies and spinal cord activity during locomotion. , 2010, Journal of neurophysiology.

[31]  Maria M. Martins,et al.  The application of cycling and cycling combined with feedback in the rehabilitation of stroke patients: a review. , 2015, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[32]  Dina Brooks,et al.  Effects of an Aerobic Exercise Program on Aerobic Capacity, Spatiotemporal Gait Parameters, and Functional Capacity in Subacute Stroke , 2009, Neurorehabilitation and neural repair.

[33]  Richard R Neptune,et al.  Modular control of human walking: Adaptations to altered mechanical demands. , 2010, Journal of biomechanics.

[34]  B Stapelfeldt,et al.  Development and Evaluation of a New Bicycle Instrument for Measurements of Pedal Forces and Power Output in Cycling , 2006, International journal of sports medicine.

[35]  R. Neptune,et al.  The effect of pedaling rate on coordination in cycling. , 1997, Journal of biomechanics.