Loss of variable fascicle gearing during voluntary isometric contractions of paretic medial gastrocnemius muscles in male chronic stroke survivors.

The present study aimed to understand variable fascicle gearing during voluntary isometric contractions of the medial gastrocnemius (MG) muscle in chronic stroke survivors. Using ultrasonography, we characterized fascicle behaviour on both paretic and non-paretic sides during plantarflexion contractions at different intensities and at different ankle joint angles. Shear wave speed was also recorded from the MG muscle belly under passive conditions. Fascicle gear ratios were then calculated as the ratio of muscle belly shortening velocity to fascicle shortening velocity, and variable fascicle gearing was quantified from the slope of gear ratio vs. joint angle relations. This slope was used to establish associations with maximum joint torques and with shear wave speeds. At all measured angles, we found a significant reduction in both maximum fascicle shortening and maximum fascicle rotation on the paretic side compared to the non-paretic side on our stroke survivor cohort. The fascicle rotation per fascicle shortening on the paretic side was also significantly smaller than on the non-paretic side, especially at plantarflexed positions. Furthermore, the fascicle gear ratio on both sides decreased as the ankle became dorsiflexed, but the change in the fascicle gear ratio was significantly lower on the paretic side. The side-to-side difference in the gear ratio slope was also strongly correlated with the relative maximum joint torque and with the relative shear wave speed, suggesting that variable gearing may explain muscle weakness after stroke. Further studies are needed to investigate how muscular changes after stroke may impede variable gearing and adversely impact muscle performance.