Proximal arm non-use optimises movement when the shoulder is weak: consequences for stroke patients

Most stroke patients do not use their paretic limb whereas they are able to. The Constraint-Induced Movement Therapy (CIMT) is effective to reverse this non-use behaviour in some patients but is inapplicable or unsuccessful on others. Here, we investigate how much non-use could come from shoulder weakness instead of the behavioural conditioning treated by the CIMT. We asked 26 healthy participants to reach a target while holding a dumbbell. We found that 18/26 participants exhibit proximal arm non-use when loaded and that non-use reduces shoulder torque of final posture. We either found that non-use improves accuracy in a high gravity field. Following optimal control policy, we explain how the non-use could be an adaptative solution when the shoulder is weak. Our results show the need to include muscular strength into cost function used to model human movement. The framework presented here suggests that psychological non-use could be treated effectively with CIMT, while physiological non-use, resulting from shoulder weakness, might respond better to anti-gravity muscles strengthening.