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. 2012 Fall;64(4):415-26.
doi: 10.3138/ptc.2011-03.

Factors that influence muscle weakness following stroke and their clinical implications: a critical review

Vicki Gray  1 , Charles L Rice, S Jayne Garland
Affiliations

Factors that influence muscle weakness following stroke and their clinical implications: a critical review

Vicki Gray et al. Physiother Can. 2012 Fall.

Abstract
in English, French

Purpose: To provide a comprehensive review of changes that occur in the muscle after stroke and how these changes influence the force-generating capacity of the muscle.

Methods: A literature search of PubMed, CINAHL, MEDLINE, and Embase was conducted using the search terms stroke, hemiparesis, muscle structure, cross sectional area, atrophy, force, velocity, and torque. There were 27 articles included in this review.

Results: Three changes occur in the muscle after stroke: a decrease in muscle mass, a decrease in fibre length, and a smaller pennation angle. In addition, the tendon is stretched and becomes more compliant. All of these factors reduce the affected muscle's ability to generate forces similar to controls or to non-paretic muscles. The result is a leftward shift in the length-tension curve, a downward shift in the torque-angle curve, and a downward shift in the force-velocity curve.

Conclusion: Changes in muscle architecture contributing to weakness, such as muscle-fibre length, pennation angle, muscle atrophy, and tendon compliance, should be prevented or reversed by means of an appropriate rehabilitation programme.

Objectif : Procéder à une étude exhaustive des changements qui surviennent dans les muscles après un accident vasculaire cérébral (AVC) et de la façon dont ces changements affectent la capacité des muscles à développer de la force. Méthode : Une recherche documentaire dans les bases de données PubMed, CINAHL, MEDLINE et Embase a été réalisée à l'aide des mots clés stroke (accident vasculaire cérébral), hemiparesis (hémiparésie), muscle structure (structure musculaire), cross sectional area (section transversale), atrophy (atrophie), force (force), velocity (vélocité) et torque (puissance). La recherche a permis de répertorier 27 articles. Résultats : À la suite d'un AVC, trois changements se produisent dans les muscles: une diminution de la masse musculaire, une diminution de la longueur des fibres musculaires et un angle de pennation. De plus, le tendon s'étire et devient plus lâche. Tous ces facteurs réduisent la capacité des muscles affectés à générer une force nécessaire pour contrôler ou similaire à celle des muscles qui ne sont pas paralysés. Le tout occasionne un glissement vers la gauche de la longueur de la courbe de tension, une poussée vers le bas de l'angle de la courbe de puissance et un abaissement similaire de la courbe de la vélocité de la force. Conclusion : À l'aide d'un programme de réadaptation approprié, il est possible de prévenir et de mettre fin aux changements dans l'architecture musculaire qui contribuent à l'affaiblissement, notamment dans la longueur des fibres musculaires et dans l'angle de pennation, de même qu'à l'atrophie musculaire et au relâchement des tendons.

Keywords: atrophy; muscles; paresis; stroke; torque.

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Figures

Figure 1
Figure 1
Schematic representation of the length–tension relationship (A), torque–angle relationship (B), and force–velocity relationship (C).
See this image and copyright information in PMC

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