Muscle synergies for evaluating upper limb in clinical applications: A systematic review

Transferring Sensor-Based Assessments to Clinical Practice: The Case of Muscle Synergies

Sensor-based assessments in medical practice and rehabilitation include the measurement of physiological signals such as EEG, EMG, ECG, heart rate, and NIRS, and the recording of movement kinematics and interaction forces. Such measurements are commonly employed in clinics with the aim of assessing patients' pathologies, but so far some of them have found full exploitation mainly for research purposes. In fact, even though the data they allow to gather may shed light on physiopathology and mechanisms underlying motor recovery in rehabilitation, their practical use in the clinical environment is mainly devoted to research studies, with a very reduced impact on clinical practice. This is especially the case for muscle synergies, a well-known method for the evaluation of motor control in neuroscience based on multichannel EMG recordings. In this paper, considering neuromotor rehabilitation as one of the most important scenarios for exploiting novel methods to assess motor control, the main challenges and future perspectives for the standard clinical adoption of muscle synergy analysis are reported and critically discussed.

Rectified Latent Variable Model-Based EMG Factorization of Inhibitory Muscle Synergy Components Related to Aging, Expertise and Force-Tempo Variations

Muscle synergy has been widely acknowledged as a possible strategy of neuromotor control, but current research has ignored the potential inhibitory components in muscle synergies. Our study aims to identify and characterize the inhibitory components within motor modules derived from electromyography (EMG), investigate the impact of aging and motor expertise on these components, and better understand the nervous system's adaptions to varying task demands. We utilized a rectified latent variable model (RLVM) to factorize motor modules with inhibitory components from EMG signals recorded from ten expert pianists when they played scales and pieces at different tempo-force combinations. We found that older participants showed a higher proportion of inhibitory components compared with the younger group. Senior experts had a higher proportion of inhibitory components on the left hand, and most inhibitory components became less negative with increased tempo or decreased force. Our results demonstrated that the inhibitory components in muscle synergies could be shaped by aging and expertise, and also took part in motor control for adapting to different conditions in complex tasks.

Motor unit modes in the calf muscles during a submaximal isometric contraction are changed by brief stretches

The purpose of our study was to investigate the influence of a stretch intervention on the common modulation of discharge rate among motor units in the calf muscles during a submaximal isometric contraction. The current report comprises a computational analysis of a motor unit dataset that we published previously (Mazzo et al., 2021). Motor unit activity was recorded from the three main plantar flexor muscles while participants performed an isometric contraction at 10% of the maximal voluntary contraction force before and after each of two interventions. The interventions were a control task (standing balance) and static stretching of the plantar flexor muscles. A factorization analysis on the smoothed discharge rates of the motor units from all three muscles yielded three modes that were independent of the individual muscles. The composition of the modes was not changed by the standing-balance task, whereas the stretching exercise reduced the average correlation in the second mode and increased it in the third mode. A centroid analysis on the correlation values showed that most motor units were associated with two or three modes, which were presumed to indicate shared synaptic inputs. The percentage of motor units adjacent to the seven centroids changed after both interventions: Control intervention, mode 1 decreased and the shared mode 1 + 2 increased; stretch intervention, shared modes either decreased (1 + 2) or increased (1 + 3). These findings indicate that the neuromuscular adjustments during both interventions were sufficient to change the motor unit modes when the same task was performed after each intervention. KEY POINTS: Based on covariation of the discharge rates of motor units in the calf muscles during a submaximal isometric contraction, factor analysis was used to assign the correlated discharge trains to three motor unit modes. The motor unit modes were determined from the combined set of all identified motor units across the three muscles before and after each participant performed a control and a stretch intervention. The composition of the motor unit modes changed after the stretching exercise, but not after the control task (standing balance). A centroid analysis on the distribution of correlation values found that most motor units were associated with a shared centroid and this distribution, presumably reflecting shared synaptic input, changed after both interventions. Our results demonstrate how the distribution of multiple common synaptic inputs to the motor neurons innervating the plantar flexor muscles changes after a brief series of stretches.

Evidence of synergy coordination patterns of upper-limb motor control in stroke patients with mild and moderate impairment

Objectives: Previous studies showed that the central nervous system (CNS) controls movements by recruiting a low-dimensional set of modules, usually referred to as muscle synergies. Stroke alters the structure and recruitment patterns of muscle synergies, leading to abnormal motor performances. Some studies have shown that muscle synergies can be used as biomarkers for assessing motor function. However, coordination patterns of muscle synergies in post-stroke patients need more investigation to characterize how they are modified in functional movements. Methods: Thirteen mild-to-moderate stroke patients and twenty age-matched healthy subjects were recruited to perform two upper-limb movements, hand-to-mouth movement and reaching movement. Muscle synergies were extracted with nonnegative matrix factorization. We identified a set of reference synergies (i.e., averaged across healthy subjects) and typical synergies (i.e., averaged across stroke subjects) from the healthy group and stroke group respectively, and extracted affected synergies from each patient. Synergy similarity between groups was computed and analyzed. Synergy reconstruction analysis was performed to verify synergy coordination patterns in post-stroke patients. Results: On average, three synergies were extracted from both the healthy and stroke groups, while the mild impairment group had a significantly higher number of synergies than the healthy group. The similarity analysis showed that synergy structure was more consistent in the healthy group, and stroke instead altered synergy structure and induced more variability. Synergy reconstruction analysis at group and individual levels showed that muscle synergies of patients often showed a combination of healthy reference synergies in the analyzed movements. Finally, this study associated four synergy coordination patterns with patients: merging (equilibrium and disequilibrium), sharing (equilibrium and disequilibrium), losing, and preservation. The preservation was mainly represented in the mild impairment group, and the moderate impairment group showed more merging and sharing. Conclusion: This study concludes that stroke shows more synergy variability compared to the healthy group and the alterations of muscle synergies can be described as a combination of reference synergies by four synergy coordination patterns. These findings deepen the understanding of the underlying neurophysiological mechanisms and possible motor control strategies adopted by the CNS in post-stroke patients.