Reviewer #2 (Public review):
Summary:
Here the authors address the idea that postural and movement control are differentially impacted with stroke. Specifically, they examined whether resting postural forces influenced several metrics of sensorimotor control (e.g., initial reach angle, maximum lateral hand deviation following a perturbation, etc.) during movement or posture. The authors found that resting postural forces influenced control only following the posture perturbation for the paretic arm of stroke patients, but not during movement. They also found that resting postural forces were greater when the arm was unsupported, which correlated with abnormal synergies (as assessed by the Fugl-Meyer). The authors suggest that these findings can be explained by the idea that the neural circuitry associated with posture is relatively more impacted by stroke than the neural circuitry associated with movement. They also propose a conceptual model that differentially weights the reticulospinal tract (RST) and corticospinal tract (CST) to explain greater relative impairments with posture control relative to movement control, due to abnormal synergies, in those with stroke.
Comments on revisions:
The authors should be commended for being very responsive to comments and providing several further requested analyses, which have improved the paper. However, there is still some outstanding issues that make it difficult to fully support the provided interpretation.
The authors say within the response, "We would also like to stress that these perturbations were not designed so that responses are directly compared to each other ***(though of course there is an *indirect* comparison in the sense that we show influence of biases in one type of perturbation but not the other)***." They then state in the first paragraph of the discussion that "Remarkably, these resting postural force biases did not seem to have a detectable effect upon any component of active reaching but only emerged during the control of holding still after the movement ended. The results suggest a dissociation between the control of movement and posture." The main issue here is relying on indirect comparisons (i.e., significant in one situation but not the other), instead of relying on direct comparisons. Using well-known example, just because one group / condition might display a significant linear relationship (i.e., slope_1 > 0) and another group / condition does not (slope_2 = 0), does not necessarily mean that the two groups / conditions are statistically different from one another [see Figure 1 in Makin, T. R., & Orban de Xivry, J. J. (2019). Ten common statistical mistakes to watch out for when writing or reviewing a manuscript. eLife, 8, e48175.].
The authors have provided reasonable rationale of why they chose certain perturbation waveforms for different. Yet it still holds that these different waveforms would likely yield very different muscular responses making it difficult to interpret the results and this remains a limitation. From the paper it is unknown how these different perturbations would differentially influence a variety of classic neuromuscular responses, including short-range stiffness and stretch reflexes, which would be at play here.
Much of the results can be interpreted when one considers classic neuromuscular physiology. In Experiment 1, differences in resting postural bias in supported versus unsupported conditions can readily be explained since there is greater muscle activity in the unsupported condition that leads to greater muscle stiffness to resist mechanical perturbations (Rack, P. M., & Westbury, D. R. (1974). The short-range stiffness of active mammalian muscle and its effect on mechanical properties. The Journal of physiology, 240(2), 331-350.). Likewise muscle stiffness would scale with changes in muscle contraction with synergies. Importantly for experiment 2, muscle stiffness is reduced during movement (Rack and Westbury, 1974) which may explain why resting postural biases do not seem to be impacting movement. Likewise, muscle spindle activity is shown to scale with extrafusal muscle fiber activity and forces acting through the tendon (Blum, K. P., Campbell, K. S., Horslen, B. C., Nardelli, P., Housley, S. N., Cope, T. C., & Ting, L. H. (2020). Diverse and complex muscle spindle afferent firing properties emerge from multiscale muscle mechanics. eLife, 9, e55177.). The concern here is that the authors have not sufficiently considered muscle neurophysiology, how that might relate to their findings, and how that might impact their interpretation. Given the differences in perturbations and muscle states at different phases, the concern is that it is not possible to disentangle whether the results are due to classic neurophysiology, the hypothesis they propose, or both. Can the authors please comment.
The authors should provide a limitations paragraph. They should address 1) how they used different perturbation force profiles, 2) the muscles were in different states which would change neuromuscular responses between trial phase / condition, 3) discuss a lack of direct statistical comparisons that support their hypothesis, and 4) provide a couple of paragraphs on classic neurophysiology, such as muscle stiffness and stretch reflexes, and how these various factors could influence the findings (i.e., whether they can disentangle whether the reported results are due to classic neurophysiology, the hypothesis they propose, or both).