Multi-level neurophysiological perspectives on impaired lower-limb muscle synergies during walking after stroke. A systematic scoping review.

Authors

Rui Yang, Zengqiang Ouyang, Yue Wang

Published in

European journal of physical and rehabilitation medicine. Nov 13, 2026. Epub Nov 13, 2026.

Abstract

Gait impairment is one of the most common and disabling consequences of stroke. Abnormal lower-limb muscle synergies represent a key constraint on poststroke gait recovery, yet their underlying neurophysiological mechanisms remain incompletely understood.
This systematic scoping review synthesizes evidence on impaired lower-limb muscle synergies during poststroke walking from a multilevel neural control perspective, with a particular focus on supraspinal and spinal regulatory processes. Following the Joanna Briggs Institute methodological framework and PRISMA-ScR guidelines, three databases were systematically searched, and nine studies were ultimately included.
The available evidence suggests that stroke-related alterations in descending motor system interactions, particularly involving corticospinal and corticoreticulospinal pathways, may be associated with abnormalities in the spatial organization and gain modulation of rhythmic neural signals within spinal networks. Although the temporal structure associated with gait rhythm generation may remain relatively preserved after stroke, altered spatial organization within these networks has been associated with reduced and merged muscle synergy modules, altered muscle weightings, and disordered activation timing. Given the limited and heterogeneous evidence currently available, this review proposes a hypothesis-generating multilevel neurophysiological framework in which the spinal networks may represent a potential integrative component contributing to poststroke muscle synergy impairments.
From this perspective, muscle synergy abnormalities may reflect functional signatures of imbalanced sensorimotor network reorganization rather than purely descriptive gait features. This hypothesis-generating framework may help inform future multimodal assessments and future mechanism-oriented rehabilitation research.

PMID:
43023926
Bibliographic data and abstract were imported from PubMed on 13 Nov 2026.

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