title: Motor Lateralization Provides a Foundation for Predicting and Treating Non-paretic Arm Motor Deficits in Stroke.
abstract: Brain lateralization is a ubiquitous feature of neural organization across the vertebrate spectrum. We have developed a model of motor lateralization that attributes different motor control processes to each cerebral hemisphere. This bilateral hemispheric model of motor control has successfully predicted hemisphere-specific motor control and motor learning deficits in the ipsilesional, or non-paretic, arm of patients with unilateral stroke. We now show across large number and range of stroke patients that these motor performance deficits in the non-paretic arm of stroke patients vary with both the side of the lesion, as well as with the severity of contralesional impairment. This last point can be functionally devastating for patients with severe contralesional paresis because for these individuals, performance of upper extremity activities of daily living depends primarily and often exclusively on ipsilesional arm function. We present a pilot study focused on improving the speed and coordination of ipsilesional arm function in a convenience sample of three stroke patients with severe contralesional impairment. Over a three-week period, patients received a total of nine 1.5 h sessions of training that included intense practice of virtual reality and real-life tasks. Our results indicated substantial improvements in ipsilesional arm movement kinematics, functional performance, and that these improvements carried over to improve functional independence. In addition, the contralesional arm improved in our measure of contralesional impairment, which was likely due to improved participation in activities of daily living. We discuss of our findings for physical rehabilitation.
authors.affiliation: Department of Kinesiology, The Pennsylvania State University, 29 Rec Building, Biomechanics Laboratory, University Park, Pennsylvania, 16802, USA. rls45@psu.edu.|Department of Neurology, Penn State Milton S. Hershey College of Medicine, Hershey, Pennsylvania, USA. rls45@psu.edu.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sainburg
authors.affiliation: Department of Kinesiology, The Pennsylvania State University, 29 Rec Building, Biomechanics Laboratory, University Park, Pennsylvania, 16802, USA.|Department of Neurology, Penn State Milton S. Hershey College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Candice
authors.initials: C
authors.lastname: Maenza
authors.affiliation: Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
authors.forename: Carolee
authors.initials: C
authors.lastname: Winstein
authors.affiliation: Department of Neurology, Penn State Milton S. Hershey College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: David
authors.initials: D
authors.lastname: Good
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001696:Biomechanical Phenomena / Q000502:physiology; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: Bilateral hemispheric model; Contralesional; Dynamic dominance; Interlimb transfer; Ipsilesional; Jebsen-Taylor hand function test; Paresis; Rehabilitation