Separating the control of moving and holding in human post-stroke arm paresis

Moving and holding-still ( holding ) have been posited to be separately controlled. The paretic arm after stroke exhibits different abnormalities during rest vs. movement, providing an opportunity to ask whether control of these behaviors is independently affected in stroke. We quantified resting postural abnormalities in human stroke patients by measuring their biases in force production as they held their hand still in various locations in a planar workspace and then assessed whether these resting force biases influenced reaching in the same workspace. Patients displayed marked resting force biases at each location, even when the arm was supported. However, these biases did not transfer to arm-supported planar reaching movements; rather, abnormal resting forces only appeared to switch on after a movement had fully stopped. These findings suggest that moving and holding are functionally separable modes of control. At the same time, resting biases mirrored characteristics of abnormal movement synergies, in line with a shared mechanism. This appears to contradict the functional separation of moving and holding observed in the same patients. To resolve this paradox, we propose a conceptual model that predicts a breakdown in this functional separation when patients move without weight support. This conceptual model posits that synergies are the manifestation of a spillover of posture into movement. Mapping these functional systems onto anatomical and physiological details of lesioned substrate after stroke may provide implementation-level insight into how normal arm motor control is assembled.