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Muscle Synergy Patterns: Managing abnormal movement after a stroke — Transcript

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0:00hi guys I'm dr. Todd Tobias on welcome
0:02you all back to my channel in today's
0:03home exercise tutorial we are going to
0:05talk about muscle synergies more
0:08specifically abnormal muscle synergies
0:10and how this differs from spasticity and
0:14how this differs from spasticity and the
0:16reason I want to differentiate it is I
0:18feel like sometimes we confuse those
0:21terms even me as a health care provider
0:22I think sometimes that I will use those
0:25terms interchangeably and they are two
0:27separate and distinct things and I think
0:30it's important to understand the
0:32difference in the terms and what an
0:35abnormal muscle synergy is why it's
0:38happening in your body and how you can
0:40use this information to help you to
0:43understand how your stroke has affected
0:45some of your movement patterns and
0:47hopefully that will help you to make the
0:50right decisions on choosing the best
0:51exercises for you but before we dive
0:54into all of that if you're new to my
0:55channel and you haven't yet subscribed
0:57go ahead and hit that subscribe button
0:58turn on that notification bell so that
1:00you'll be notified every time I upload
1:01new videos and now let's go ahead and
1:04get started on a topic that not gonna
1:06lie I'm pretty excited to talk about I
1:08love to talk about anything related to
1:10movement or abnormal movement more
1:13equipped you're gonna be not only to
1:15handle what's going on with you mentally
1:18as far as what's going on with your
1:19movement but also help you physically to
1:23recover so first and foremost what is a
1:27muscle synergy pattern so a muscle
1:30synergy pattern in itself isn't
1:32necessarily a bad thing
1:34muscle synergy is really just a
1:36mechanism where groups of muscles work
1:39together to execute a specific skill or
1:42a specific task so most tasks require
1:45more than one muscle or more than one
1:47muscle group and more than one joint is
1:49moving in a lot of cases for instance
1:50reaching or walking so the amazingness
1:55of how our brains function is that the
1:58brain basically has built-in function
2:01keys so something I learned probably
2:04much later than most in life are low
2:07command C and command V for a copy and
2:09paste very very
2:11what a muscle synergy is instead of
2:14having to go highlight the word go up to
2:18the Edit box drop-down box hit copy go
2:20to where you want to put it put the
2:22cursor there go back up scroll down
2:24again hit paste you basically just do
2:27command C or command V very similar so
2:29the brain has kind of built in some
2:32synergies in order to be able to
2:34consistently execute a specific movement
2:37related to a specific task that we do
2:40over and over and over again so that is
2:43normal muscle synergies and why they
2:46exist they're basically command keys in
2:48our brain that group muscles together to
2:50execute certain movements that we
2:52perform over and over and over again
2:54throughout the day and the way I like to
2:56view this in really this analogy or this
2:58vision was pretty much inspired due to
3:00this quarantine and all these artists
3:02and singers that are doing all these
3:04performances got me thinking and muscle
3:06synergies have a lot of characteristics
3:08of music not that I'm a musician and I'm
3:12probably gonna totally botch this up
3:14from a technical standpoint as far as
3:15music goes but it muscles remind me of
3:18wards or keys there's only so many keys
3:20but depending on how you put them in
3:22order you're gonna create a different
3:23sound very very similar same group of
3:26muscles depending on the task you get
3:28those chords or you get those muscles
3:30all firing at the exact time in the
3:33exact order you're gonna get this
3:35beautiful smooth movement in music if
3:38you get all those chords lined up
3:40correctly in the right order and they're
3:41timed perfectly you get a very pretty
3:44sound very very similar so I hope that
3:47helps to kind of make these muscle
3:49synergies make sense so now what is an
3:52abnormal muscle synergy and an abnormal
3:55muscle synergy does happen after a
3:57stroke or a brain injury and it's
4:00basically a pattern or a grouping of
4:03muscles to create a specific movement
4:05however it might not be functional some
4:08of the literature has identified too
4:11when it comes to stroke in the arm and
4:13the leg and I've talked about this a lot
4:15in other videos you have a flexor
4:18pattern in the upper extremity and an
4:20extensor pattern in the upper extremity
4:22those are work groups of muscles are
4:24working together to create a movement
4:26same thing in the lower extremity you
4:29have a flexor synergy pattern where the
4:31hip flexes the knee flexes and the ankle
4:34dorsi flexes in an extensor synergy
4:36pattern where the hip extends the knee
4:38extends and the foot points and that's
4:40extremely simplified but that's the
4:42basic movement and those kind of emerged
4:45after a stroke or a brain injury so it
4:48happens is you get these abnormal
4:50movement patterns when you're trying to
4:51execute a skill that might not be
4:53appropriate to the skill so I'm gonna
4:55explain that a little bit more but
4:56what's really important is that is very
4:58different from spasticity now I know I
5:02use these terms interchangeably
5:03sometimes when I'm explaining why a
5:06specific abnormal movements happening
5:08and that's because a lot of times are
5:10occurring at the same time but
5:12spasticity is more at the muscle level
5:14and I will put a link in the description
5:15below where I talk about spasticity
5:17specifically and what it is
5:19so spasticity is an involuntary
5:22hyperexcitability of a group of muscles
5:25that is velocity dependent the way that
5:27we test this is will quickly lengthen
5:29the muscle and if we get this
5:30involuntary response in that muscle
5:32group then that would indicate that
5:35someone has spasticity in a specific
5:37muscle group now how we would know if
5:40someone has an abnormal synergy pattern
5:43is we would ask them to execute a
5:45specific movement or specific skill and
5:48if it looked disjointed or we saw one of
5:50these patterns these flexor extensor
5:53patterns occur while someone was trying
5:55to perform a skill that wasn't really
5:57appropriate to that skill then we would
5:59identify that as an abnormal synergy
6:02pattern so there definitely two separate
6:06and distinct terms however it's also
6:08important to note as I stated earlier
6:10that they can be going on simultaneously
6:14now why do you end up having these
6:17abnormal movement patterns where muscles
6:20are linked together now there's lots of
6:22theories out there no one really knows
6:24can say for sure why this happens the
6:27one that makes the most sense to me is
6:29in a healthy brain we have a lot of
6:33command keys or lots of center
6:36patterns so walking is not just one
6:39synergy pattern but with each leg
6:41movement
6:42because it's an active walking as a
6:44repetitive activity where you want to
6:47create that consistent stepping pattern
6:49there's multiple built in synergy
6:51patterns or command keys and it's like
6:53that with a lot of repetitive movements
6:57and what they're finding is that after a
6:59stroke an individual has fewer has less
7:03of those built-in normal functional
7:07synergy movement patterns and so at best
7:09guess that because you have fewer of
7:14these normal movements energy patterns
7:17the ones that you are left with are just
7:19coming up to the surface
7:21whenever you're trying to perform some
7:24of these other functional tasks where
7:26you used to have more synergy patterns
7:28now you're relying on fewer synergy
7:30patterns so that's one explanation but
7:33there's actually also another
7:35explanation that I think based on what I
7:37see clinically also makes a lot of sense
7:39to me and that's that you have less
7:42control from the brain depending on
7:46where the stroke happened so with less
7:49control and less organization in the
7:52brain there's just less ability to use
7:56these movements energy patterns
7:58appropriately so the brains the control
8:00tower there's an area of the brain
8:01that's damaged that used to be
8:03responsible for a given task so there's
8:06no teacher there's no no one directing
8:09that ship and so there's just chaos that
8:12kind of makes sense to me to that you
8:13just have less coming from the control
8:16tower so the kids are the things that
8:17are being controlled are just a little
8:19bit more sporadic so that kind of makes
8:21sense to me as well but in either case
8:22or of whether or not we know the exact
8:25mechanism or why this happens the end
8:29result is you are left with these
8:31synergy patterns that interfere with
8:34normal movement so now how do you treat
8:38this or how do you prevent this or
8:41minimize these
8:43normal muscle synergies from kicking and
8:45at inappropriate times and it goes back
8:48to everything that I say in so many
8:51videos neuroplasticity you want to
8:54restore as much normal functioning in
8:57the brain as possible and the best way
9:01to do that is to execute normal movement
9:06patterns over and over and over again
9:11with the goal that the brain that main
9:15hub that I told you is not working
9:18appropriately and is creating or
9:20interfering or causing some of these
9:22abnormal muscle synergies to happen you
9:25want that reorganization to occur in the
9:28brain so that it can take over and
9:31normalize movement patterns by
9:33inhibiting those abnormal muscle
9:35synergies when necessary so I will put a
9:39link in the description below for the
9:42video that I did on motor control
9:44because I think it's extremely valuable
9:47this video on muscle synergies cannot
9:52really be watched in isolation it's
9:55really part of the bigger picture of
9:57normal functioning brain damaged brain
10:01and how you get the best result at
10:04getting back to that normal functioning
10:06brain as possible there's a few key
10:08concepts that are absolutely critical
10:11for you as a stroke survivor to
10:13understand in order to maximize your
10:15potential in your recovery so that motor
10:18control video that I did is extremely
10:21important neural plasticity and
10:23understanding that is extremely
10:25important a lot of people in this
10:27channel use that term in the comments so
10:29I think I automatically assume that
10:31everyone really understands what that
10:32term means but if you want me to do a
10:34video on what positive neuroplasticity
10:37is and what neck
10:39Plus this is because it definitely
10:41exists and what might be causing some of
10:44you to actually develop more neural
10:46control on the uninvolved side or the
10:48undamaged side of the brain put hashtag
10:50neuroplasticity in the comments because
10:53I would be happy to talk about that and
10:56how you can maximize positive
10:58neuroplasticity and really minimize that
11:01negative neuroplasticity so again
11:03hashtag neuroplasticity in the comments
11:05if you want to really understand a
11:07little bit deeper what positive
11:09neuroplasticity is but now back to how
11:12you treat or manage abnormal muscle
11:15synergies it does go back to that
11:17concept of neuroplasticity you want to
11:19do things over and over and over and
11:21over again in normal or near-normal
11:26movement patterns so back to that music
11:29analogy I've been thinking about this
11:31music analogy a lot in the last couple
11:32of days and my botched attempt at
11:36learning instruments way back in grade
11:38school when you had to take music
11:40lessons and kind of linking that with
11:42this concept or this idea of
11:44neuroplasticity or minimizing some of
11:49these abnormal muscle synergies is
11:51you've got to go back to the basics I am
11:54NOT going to learn the keyboard and make
11:56beautiful music by starting with
11:59something super complicated I'm kind of
12:02at the mary had a little lamb' level and
12:04I probably really never got past the
12:06mary had a little level but I could do
12:09that all day long
12:10now if I was really serious about
12:13learning the piano I would do that all
12:16day long until I developed the
12:17coordination my fingers to make that
12:19automatic and make a sound that sounded
12:22like mary had a little lamb and I would
12:24do it over and over and over again
12:27now give me something complicated and
12:30maybe even something a song that
12:31requires two hands on the piano which I
12:33really don't even know how to do it's
12:36not gonna sound pretty and what am i
12:38learning I'm creating horrible sound I'm
12:40not creating a song that anyone would
12:43want to listen to and I'm not
12:45learning anything so same chords right
12:48you've got the same notes or the same
12:50keys but I'm just banging on that
12:52keyboard because I don't have the
12:54control to make that pretty sound so how
12:57do you decrease these abnormal muscle
13:01synergies is you go back to the basics
13:04and what I do clinically is eliminate
13:08how many planes of movement are going on
13:10so if someone's working on reaching or
13:13if you're working on reaching I'm
13:16probably gonna only work in one plane
13:19even though we reach in multiple planes
13:21right I'm probably just gonna have
13:24someone work on reaching forward
13:26reaching backwards reaching forward
13:28reaching backwards one plane of movement
13:31I'm gonna minimize how many keys need to
13:33be playing at the same time - maybe just
13:36one key or one chord needing to be
13:39played at any given moment to simplify
13:42it and then you can add complexity later
13:46on by practicing reaching and multiple
13:49planes same thing with walking I'm gonna
13:51have someone walk in a straight plane I
13:54maybe even break it down one step
13:57further and have someone perform one
13:59section of a song over and over and over
14:04again and get really good at it and then
14:06link all the sections together for
14:08instance forward and backward stepping
14:10in a single plane move the foot forward
14:12move the foot back if you've been
14:14watching my videos for a while I give a
14:16ton of different strategies or ideas on
14:20how to break skills down if any of you
14:23have watched the one where the foots on
14:24the skateboard that's one method where I
14:27eliminate having to lift the leg and you
14:30can just rest the leg down and you're
14:33literally just working how to extend the
14:36knee without pointing the foot so now
14:38you're inhibiting a synergy pattern
14:41hopefully that's the goal of that by not
14:43everything extending at the same time
14:45but just extending the knee to advance
14:47the leg and then bringing it back
14:49without the foot pointing I will put a
14:50link for that video in the description
14:52below because I know I'll get some
14:53comments on that but that is one of the
14:56thought processes behind
14:57activity that I use quite a bit is
14:59breaking a skill down so it's not just
15:02stepping the leg forward but I've pretty
15:04much eliminated the hip altogether and
15:06just worked on that knee movement so I
15:09hope that makes sense and I hope that
15:11encourages a lot of you not to get too
15:14far ahead of yourself
15:15it is okay to break skills down now that
15:18does bring me to another point I'm
15:19probably gonna do a whole video on this
15:21because I do get this comment time and
15:24what about like actual exercising so a
15:27lot of people want to get on a treadmill
15:30and walk or are asking me about
15:32stationary bikes and is that good I
15:35don't really necessarily have an opinion
15:38or a set in stone rule for or against
15:43stationary bikes or treadmills I would
15:45say the question to ask yourself if you
15:47are at wondering about these things for
15:50exercise is how present is an ab normal
15:55synergy pattern so for the treadmill and
15:58the bike a lot of times you're gonna see
15:59the extensor synergy pattern really
16:02emerge where the knee extends the foot
16:05planner flexes and that's all you get 90
16:08percent of the gait cycle or the pedal
16:11stroke all you're getting is that
16:13extension is that productive or
16:15counterproductive and if so is it worth
16:18it to keep doing that specific skill for
16:21exercise knowing that you're really
16:24never gonna inhibit that specific
16:26abnormal movement pattern because you're
16:29reinforcing it so many times especially
16:32on a recumbent bike 20 minutes on a
16:34recumbent bike at 60 rpms like how many
16:38times have you repeated that movement
16:40over and over and over and over again
16:41just facilitating that extent source
16:43energy pattern so that would be
16:45something that I would think about and
16:47is it worth it to get the exercise that
16:50you're looking for or are there other
16:51ways depending on what your goals are
16:54most of the time people say their goal
16:56is that they've gained weight after the
16:57stroke and they want to lose weight
16:58that's why they do the treadmill and the
17:01stationary bike are there other ways to
17:04increase your activity level decrease
17:06what's going in your mouth or change
17:09what's going in your mouth because
17:10that's probably a big
17:11problem as far as weight gain than
17:14actually your activities but are there
17:17other activities that you can choose
17:18such as just standing how much time you
17:21spend sitting watching television things
17:23like that could you stand more things
17:25like that could you evaluate other areas
17:28in your life where you could come up
17:30with ways to increase your activity
17:33level decrease what's going in your
17:35mouth or change what's going in your
17:36mouth change your nutrition a little bit
17:38to get your weight under control get
17:41your diabetes under control things like
17:43that so when it comes to weight
17:45management I'm a huge advocate at
17:47looking at a 24-hour period and what's
17:51going on in that 24-hour period when
17:53most people just want to focus on that
17:5530 or 60 minutes where they feel like
17:57they need to do this vigorous intensity
17:59exercise it's what are you doing in a
18:0224-hour period and that is cumulative to
18:06keeping your weight under control so
18:08that's your goal and you know based on
18:11what I just talked about that you are
18:13reinforcing an abnormal synergy pattern
18:16when you get on that bike or you get on
18:18that treadmill and the consequences of
18:20that are there other things that you can
18:22look at to evaluate that and maybe do a
18:24different activity someone brought up
18:26actually recently in the last couple of
18:28days walking their dog can someone else
18:30help you walk your dog and I mean that
18:33legitimately like are you doing it for
18:35exercise are you doing it because you
18:37really don't have anyone else to help
18:39you walk your dog
18:40where does walking your dog fall on the
18:43importance scale as far as your quality
18:46of life versus normalizing your movement
18:49patterns just things to ask yourself I
18:52don't think there's a right or wrong
18:53answer either way I have this discussion
18:56with every single one of my patients
18:58when they hit the two-year mark is that
19:00you really do need to figure out what
19:03are you okay with what abnormal
19:05synergies or abnormal movement patterns
19:07are you gonna be okay with having long
19:09term and maybe being okay with doing
19:12some of these things even though they
19:13are creating I'm home
19:15and patterns so again I'm not for or
19:17against it but again these videos are
19:19designed to just help you understand
19:21what's going on in your body so that you
19:23can make the best decisions for you so I
19:26hope that all made sense I hope that
19:27wasn't too confusing I hope I cleared up
19:29the air between the difference between
19:32spasticity and an abnormal synergy
19:36pattern and please forgive me for the
19:39times that I use them interchangeably
19:40but they are two separate and distinct
19:43things that are going on due to the
19:45damage to your nervous system so I hope
19:47that is now more clear and then I hope
19:49you have a better understanding of these
19:51terms to help you make the best
19:53decisions for you based on your
19:55long-term goals so again I thank you all
19:57for sticking this video out there
20:00letting me rant a little bit full
20:01disclosure I didn't have a little
20:04outline ready like I normally do so I
20:06might have rambled a little bit but I
20:08hope that you guys got something out of
20:10this video I enjoyed spending time with
20:12you all today I hope you all are hanging
20:14in there I hope you're all staying safe
20:16and I look forward to seeing you all in
20:17the next video you all have a great day
20:21[Music]

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