title: Cross-education of strength has a positive impact on post-stroke rehabilitation: a systematic literature review.
abstract: BACKGROUND
  Since its discovery in 1894 cross-education of strength - a bilateral adaptation after unilateral training - has been shown to be effective in the rehabilitation after one-sided orthopedic injuries. Limited knowledge exists on its application within the rehabilitation after stroke. This review examined the evidence regarding the implication of cross-education in the rehabilitation of the post-stroke hemiplegic patient and its role in motor function recovery.
  
  
  METHODS
  Electronic databases were searched by two independent assessors. Studies were included if they described interventions which examined the phenomenon of cross-education of strength from the less-affected to the more-affected side in stroke survivors. Study quality was assessed using the PEDro scale and the Cochrane risk of bias assessment tool.
  
  
  RESULTS
  Only two controlled trials met the eligibility criteria. The results of both studies show a clear trend towards cross-educational strength transfer in post-stroke hemiplegic patients with 31.4% and 45.5% strength increase in the untrained, more-affected dorsiflexor muscle. Results also suggest a possible translation of strength gains towards functional task improvements and motor recovery.
  
  
  CONCLUSIONS
  Based on best evidence synthesis guidelines the combination of the results included in this review suggest at least a moderate level of evidence for the application of cross-education of strength in stroke rehabilitation. Following this review it is recommended that additional high quality randomized controlled trials are conducted to further support the findings.
authors.affiliation: a Health Science & Physiology Laboratory , School of Science, Institute of Technology , Sligo , Ireland.
authors.forename: Monika
authors.initials: M
authors.lastname: Ehrensberger
authors.affiliation: a Health Science & Physiology Laboratory , School of Science, Institute of Technology , Sligo , Ireland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Simpson
authors.affiliation: a Health Science & Physiology Laboratory , School of Science, Institute of Technology , Sligo , Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Broderick
authors.affiliation: a Health Science & Physiology Laboratory , School of Science, Institute of Technology , Sligo , Ireland.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Monaghan
mesh_terms: D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D055070:Resistance Training / Q000379:methods*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D014163:Transfer, Psychology / Q000502:physiology*
keywords: Cross-education; Rehabilitation; Strength transfer; Stroke; Unilateral strength training