EMG Signs of Motor Units' Enlargement in Stroke Survivors

The degeneration of lower motoneurons has often been reported in stroke survivors, with possible collateral reinnervation from the surviving motoneurons to the denervated muscle fibers. Under this assumption, a stroke would be expected to increase the size of motor units in paretic muscles. We indirectly address this issue with electrical stimulation and surface electromyography, asking whether stroke leads to greater variations in the amplitude of M waves elicited in paretic muscles than in contralateral, non-paretic muscles. Current pulses at progressively greater intensities were applied to the musculocutaneous nerve, stimulating motoneurons supplying the biceps brachii of eight stroke patients. The size of increases in the amplitude of M waves elicited consecutively, hereafter defined as increments, was considered to evaluate changes in the innervation ratio of biceps brachii motor units following stroke. Our findings showed that patients presented significantly (p = 0.016) greater increments in muscles of paretic than in non-paretic limbs. This result corroborates the notion that collateral reinnervation takes place after stroke, enlarging motor units' size and the magnitude of the muscle responses. Therefore, the non-invasive analysis proposed here may be useful for health professionals to assess disease progression by tracking for neuromuscular changes likely associated with clinical outcomes in stroke survivors, such as in the muscles' strength.