In patients with stroke, two basic limb synergies can be distinguished for the paretic upper limb, viz. As a consequence, the joints that are coupled within a synergy cannot be mastered in isolation. These basic limb synergies involve pathological couplings between shoulder and elbow movements, which are the result of increased co-activation between muscles in the paretic upper limb that can be elicited voluntarily or as a reflexive reaction (Twitchell 1951). He noted a remarkable uniformity in the manner and sequence in which basic limb synergies emerged before isolated movements of the various joints could be mastered. Recovery of upper limb function after stroke typically evolves in a rather predictable pattern that has been explicitly described by Twitchell ( 1951). These significant relations indicate that PCA is a useful tool to identify clinically meaningful interactions between compensatory trunk movements and pathological synergies in the elbow and shoulder during reach-to-grasp after stroke. The presence or absence of basic limb synergies as determined by means of the FMA was significantly related to components 2 ( p = 0.014) and 3 ( p = 0.003) in patients with stroke. The presence of the flexion synergy (Shoulder Abduction and Elbow Flexion) was reflected by component 1, whereas the compensatory role of trunk movements for lack of shoulder and elbow movements was reflected by components 2 and 3 respectively. Visual inspection revealed that the contribution of joint and trunk angles to each component differed substantially between groups. Four and three principal components were extracted in patients with stroke and healthy individuals, respectively. Using multivariate logistic regression analysis, we investigated whether component scores were related to the presence or absence of basic limb synergies as indicated by the arm section of the Fugl-Meyer motor assessment (FMA). We used principal component analyses (PCA) to identify components representing linear relations between the degrees of freedom of the upper limb and trunk across patients with stroke and healthy participants. 3D kinematic joint and trunk angles were measured during a reach-to-grasp movement in 46 patients with stroke and 12 healthy individuals. Note that some muscles are not usually involved in these synergy patterns and include the lattisimus dorsi, teres major, serratus anterior, finger extensors, and ankle evertors.The aim of the present study was to identify how pathological limb synergies between shoulder and elbow movements interact with compensatory trunk movements during a functional movement with the paretic upper limb after stroke. The extension synergy for the lower extremity includes hip extension, adduction and internal rotation, knee extension, ankle plantar flexion and inversion, and toe plantar flexion. The flexion synergy for the lower extremity includes hip flexion, abduction and external rotation, knee flexion, ankle dorsiflexion and inversion and toe dorsiflexion. The extension synergy for the upper extremity includes scapular protraction, shoulder adduction and internal rotation, elbow extension, forearm pronation, and wrist and finger flexion. The flexion synergy for the upper extremity includes scapular retraction and elevation, shoulder abduction and external rotation, elbow flexion, forearm supination, and wrist and finger flexion. Obligatory synergy patterns are observed when a patient tries to make a minimal voluntary movement, or as a result of stimulated reflexes. Careful thought should, therefore, be considered in deciding which muscle groups to stretch at specific times during recovery. Some aspects of the obligatory synergy patterns however, can be cleverly used to increase function relative to the movement available to the individual. This interferes with normal activities of daily living. When these patterns occur in a patient, he or she is unable to move a limb segment in isolation of the pattern. They are described as either a flexion synergy or an extension synergy and affect both the upper and lower extremity (see below). It manifests in abnormal and stereotypical patterns across multiple joints called obligatory synergies. In medicine, obligatory synergies occur when spasticity appears, such as following a stroke. Please help improve this article by introducing citations to additional sources.įind sources: "Obligatory synergies" – news Relevant discussion may be found on the talk page. This article relies largely or entirely on a single source.
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