Send to

Choose Destination
J Neurophysiol. 2018 Mar 1;119(3):1095-1112. doi: 10.1152/jn.00570.2017. Epub 2017 Dec 6.

Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation.

Kaupp C1,2,3, Pearcey GEP1,2,3, Klarner T1,2,3, Sun Y1,2,3, Cullen H1,2,3, Barss TS4, Zehr EP1,2,3,5.

Author information

Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.
Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.
Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada.
Human Neurophysiology Laboratory, University of Alberta , Edmonton, Alberta , Canada.
Division of Medical Sciences, University of Victoria , Victoria, British Columbia , Canada.


Training locomotor central pattern-generating networks (CPGs) through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5 wk of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Clinical function tests assessed walking, balance, and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion, and muscle activation. "Normalization" of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during the swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflex amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. NEW & NOTEWORTHY It has been suggested but not tested that training the arms may influence rehabilitation of walking due to activation of interneuronal patterning networks after stroke. We show that arm cycling training improves strength, clinical function, coordination of muscle activity during walking, and neurological connectivity between the arms and the legs. The arms can, in fact, give the legs a helping hand in rehabilitation of walking after stroke.


arm cycling; cutaneous reflex; locomotor training; stretch reflex; stroke

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center