Reduced Kinematic Redundancy and Motor Equivalence During Whole-Body Reaching in Individuals With Chronic Stroke.

Kinematic redundancy of the human body provides abundant movement patterns to accomplish the same motor goals (motor equivalence). Compensatory movement patterns such as excessive trunk displacement in stroke subjects during reaching can be viewed as a consequence of the motor equivalent process to accomplish a task despite limited available ranges in some joints. However, despite compensations, the ability to adapt reaching performance when perturbations occur may still be limited when condition-specific changes of joint angles are required. We addressed this hypothesis in individuals with and without stroke for reaching a target placed beyond arm reach in standing while flexing the hips (free-hip condition). In randomly selected trials, hip flexion was unexpectedly blocked, forcing subjects to take a step (blocked-hip condition). In additional trials, subjects took an intentional step while reaching the target (intentional-step condition). In blocked-hip trials, healthy subjects maintained smooth and precise endpoint trajectories by adapting temporal and spatial interjoint coordination to neutralize the effect of the perturbation. However, the ability to produce motor equivalent solutions was reduced in subjects with stroke, evidenced by substantial overshoot errors in endpoint position, reduced movement smoothness and less adaptive elbow-shoulder interjoint coordination. Movement adaptability was more limited in stroke subjects who used more compensatory movements for unperturbed reaching. Results suggest that subjects with mild-to-moderate stroke only partially adapted arm joint movements to maintain reaching performance. Therapeutic efforts to enhance the ability of individuals with stroke to find a larger number of task-relevant motor solutions (adaptability) may improve upper limb recovery.