Perspective on neuromuscular factors in poststroke fatigue

Abstract

Purpose: To summarize the potential origins of fatigue poststroke from a neuromuscular perspective, including stroke-induced alterations at the cortical, spinal and muscle levels. Method: Perspective based on narrative literature review. Results: Fatigue is a highly prevalent, but poorly understood symptom poststroke. Neuromuscular fatigue has central and peripheral origins. Individuals with stroke experienced greater central fatigue and less peripheral fatigue during voluntary contractions of the paretic leg in comparison to healthy participants. Neuromuscular adaptations to stroke create an increased susceptibility to central fatigue, which may be a contributing factor to the increased perception of tiredness during performance of activities of daily living. Future studies should investigate whether intervention-induced cortical plasticity, gains in muscle strength and endurance will attenuate self-reported fatigability. Conclusions: Fatigue is a common and debilitating consequence of stroke. Neuromuscular fatigue of central origin may contribute to self-reported fatigue. Continued focused and properly designed research studies should provide substantial insight into the therapeutic interventions that will improve the management of fatigue poststroke.

Implications for Rehabilitation

• Fatigue is a common and debilitating consequence of stroke, which has received little attention in clinical rehabilitation.

• Insufficient understanding of the pathophysiology of poststroke fatigue limits advances in its treatment.

• Neuromuscular fatigue of central origin may contribute to the self-reported fatigue poststroke.

• Although speculative, rehabilitation interventions that foster neuroplasticity, muscle strength and endurance may have a role in the management of fatigue poststroke.

Keywords::

• Central fatigue
• fatigue poststroke
• stroke
• neuromuscular
• peripheral fatigue
• stroke

Declaration of Interest: This work was funded, in part, through a grant from the Heart and Stroke Foundation of Ontario (SRA 5974).