Factors That Influence Muscle Weakness Following Stroke and Their Clinical Implications: A Critical Review

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.