But useless since no protocols were created to increase this cortical excitability. You list 4 issues needing explanation: WRONG, WRONG, WRONG. There is only one issue; How do you 100% recover the hand?
Resting motor threshold in the course of hand motor recovery after stroke: a systematic review
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 158 (2021)
Abstract
Background
Resting motor threshold is an objective measure of cortical excitability. Numerous studies indicate that the success of motor recovery after stroke is significantly determined by the direction and extent of cortical excitability changes. A better understanding of this topic (particularly with regard to the level of motor impairment and the contribution of either cortical hemisphere) may contribute to the development of effective therapeutical strategies in this cohort.
Objectives
This systematic review collects and analyses the available evidence on resting motor threshold and hand motor recovery in stroke patients.
Methods
PubMed was searched from its inception through to 31/10/2020 on studies investigating resting motor threshold of the affected and/or the non-affected hemisphere and motor function of the affected hand in stroke cohorts.
Results
Overall, 92 appropriate studies (including 1978 stroke patients and 377 healthy controls) were identified. The analysis of the data indicates that severe hand impairment is associated with suppressed cortical excitability within both hemispheres and with great between-hemispheric imbalance of cortical excitability. Favorable motor recovery is associated with an increase of ipsilesional motor cortex excitability and reduction of between-hemispheric imbalance. The direction of change of contralesional motor cortex excitability depends on the amount of hand motor impairment. Severely disabled patients show an increase of contralesional motor cortex excitability during motor recovery. In contrast, recovery of moderate to mild hand motor impairment is associated with a decrease of contralesional motor cortex excitability.
Conclusions
This data encourages a differential use of rehabilitation strategies to modulate cortical excitability. Facilitation of the ipsilesional hemisphere may support recovery in general, whereas facilitation and inhibition of the contralesional hemisphere may enhance recovery in severe and less severely impaired patients, respectively.
Introduction
Stroke is the leading cause of long-term disability in adults world-wide [1]. In consequence, rehabilitation and optimized care of stroke survivors is of high socio-economic priority. Motor impairment is the most common clinical deficit after stroke [1] and its recovery usually remains incomplete. Six months after the cerebro-vascular incident 60 to 70 percent of stroke survivors suffer from motor impairment of one hand which significantly impacts disability and activities of daily living [2, 3]. Up to now, tens of studies have shown that motor recovery after stroke is accompanied by reorganization of the functional network architecture within both the lesioned and the non-lesioned hemisphere [4, 5]. Nevertheless, the mechanism underlying recovery of motor function after a focal lesion is still not sufficiently understood.
Transcranial magnetic stimulation (TMS) is a neurophysiological method often used to probe neural processing related to hand motor function/recovery after stroke. A comprehensive analysis of these data may help to foster our understanding of the neurophysiological changes in cortical excitability accompanying motor recovery and, at the same time, may contribute to optimize stroke rehabilitation. For this reason, we performed a review on the relationship of changes in corticospinal excitability within the ipsi- and contralesional hemisphere (as measured by TMS) and the functional outcome of the affected hand after stroke. This review summarizes current data on resting motor threshold and hand motor function over the course of recovery after stroke and compares these data with the data of healthy subjects. Following issues need to be clarified: (1) Is the cortical excitability of the ipsi- and the contralesional hemisphere in stroke patients higher or lower in comparison to a healthy brain? (2) Is the between-hemispheric balance of cortical excitability in stroke subjects shifted toward the contra- or ipsilesional hemisphere? (3) Is there a relationship between the level of cortical excitability within either hemisphere and the between-hemispheric imbalance? (4) Is there a relationship between the level of cortical excitability within either hemisphere and/or the between-hemispheric imbalances, and the motor function/motor recovery of the affected hand?
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