Bilateral Synergy: A Framework for Post-Stroke Rehabilitation

 Bilateral stuff has been talked about for years; just writeup a stroke protocol on it instead of this useless repeat research. People need to be fired for not knowing what has gone on before.

• bilateral (29 posts to January 2012)

• Bilateral Arm Reaching Test (1 post to May 2013)

• bilateral arm training (8 posts to December 2020)

• bilateral exercise (1 post to January 2022)

• bilateral functional connectivity (1 post to June 2020)

• Bilateral Leg Exercise (2 posts to February 2020)

• bilateral leg training with rhythmic auditory cueing (1 post to June 2020)

• bilateral priming (6 posts to October 2019)

• bilateral robot therapy (1 post to April 2020)

• bilateral training (1 post to February 2021)

• bilateral transcutaneous electrical nerve stimulation (1 post to December 2021)

• bilateral upper limb training (1 post to July 2021)

• Robot-assisted bilateral arm therapy (2 posts to December 2019)

Bilateral Synergy: A Framework for Post-Stroke Rehabilitation

 Sainburg RL 1,2*, 

Good D 2, 

and Przybyla A 1,2
1  Department of Kinesiology, Pennsylvania State University, USA
2  Department of Neurology, Penn State Hershey Medical Center, USA

Abstract

Background:
Unilateral stroke produces debilitating deficits in voluntary control in the contralesional arm, and significant motor coordination deficits in the ipsilesional arm. In addition, patients tend to avoid bilateral arm patterns during performance of activities of daily living. Nevertheless, upper extremity physical rehabilitation predominantly focuses on motor training activities with only the paretic arm. This can be limiting because of persistent deficits in the ipsilesional arm, and because of the tendency of patients to avoid spontaneous bilateral arm patterns.
Proposition:
Rehabilitation should focus on bilateral training to advance recovery of function in both arms of stroke patients, as well as to facilitate spontaneous bilateral arm use. This paper reviews the rationale for this approach, citing evidence for significant hemisphere specific bilateral motor deficits in stroke patients, which affect both the contralesional and the ipsilesional arm. The rationale for, and advantages of, training both arms simultaneously through bilateral tasks is reviewed. Although bilateral training has been employed to treat stroke patients previously, this has tended to focus on bimanual ‘coupling’ as a rationale for performing parallel, but not cooperative bilateral tasks. Bilateral synergy provides a more functional framework for structuring post-stroke upper extremity rehabilitation.

Conclusion:

Bilateral synergy may be causally linked to spontaneous bilateral arm use, suggesting that rehabilitation should be focused on bilateral cooperative
tasks, such as bilateral object transport. Further research is required to determine
whether this approach could be efficacious for patients with hemiparesis, and whether both left and right hemisphere strokes can benefit from such intervention.