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1 Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Rehabilitation Research & Development Center, VA Palo Alto HCS, Palo Alto, CA, USA; Department of Physical Therapy and Brooks Center for Rehabilitation Studies, University of Florida, Gainesville, FL, USA
2 Rehabilitation Research & Development Center, VA Palo Alto HCS, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
* To whom correspondence should be addressed. E-mail: skautz{at}phhp.ufl.edu.
Following stroke, paretic leg motor impairment is typically viewed as a unilateral control deficit. However, much of the neural circuitry controlling normal leg function is organized bilaterally to produce coordinated, task-specific activity in the two legs. Thus, as a result of contralesional neural control processes, paretic leg motor pattern generation may be substantially influenced by the non-paretic leg sensorimotor state during bilateral lower limb tasks. Accordingly, we investigated whether different paretic leg motor patterns are observed during mechanically equivalent bilateral and unilateral tasks, and, if so, whether non-paretic leg participation improved or exacerbated paretic leg coordination deficits. A pedaling apparatus that mechanically decoupled the legs was used to present subjects with increasingly complex bilateral and unilateral motor tasks: isometric force generation, discrete movement, and pedaling. Bilateral EMG and pedal force data were collected from twenty-one persons with chronic post-stroke hemiparesis and eleven similarly aged controls. During isometric force generation and discrete movements, non-paretic leg influences on paretic leg coordination were similar and not markedly different from interlimb influences in controls. In bilateral pedaling, however, interlimb influences differed from controls such that paretic leg coordination deficits were exacerbated. During pedaling movements, the suppression of interlimb influences similar to those observed in isometric and discrete movement may occur in controls, but may be disrupted in hemiparesis. We suggest that the coupling of pattern generation between the two legs may result in greater, albeit more impaired, paretic leg motor output during bilateral pedaling than during unilateral pedaling.
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