Role of the Contralesional vs. Ipsilesional Hemisphere in Stroke Recovery

被引:163
作者
Dodd, Keith C. [1 ]
Nair, Veena A. [2 ]
Prabhakaran, Vivek [2 ,3 ,4 ,5 ,6 ,7 ]
机构
[1] Univ Wisconsin, Dept Biomed Engn, Madison, WI USA
[2] Univ Wisconsin, Dept Radiol, Sch Med & Publ Hlth, Madison, WI 53706 USA
[3] Univ Wisconsin, Med Scientist Training Program, Sch Med & Publ Hlth, Madison, WI 53706 USA
[4] Univ Wisconsin, Neurosci Training Program, Madison, WI 53706 USA
[5] Univ Wisconsin, Dept Neurol, Madison, WI 53706 USA
[6] Univ Wisconsin, Dept Psychol, 1202 W Johnson St, Madison, WI 53706 USA
[7] Univ Wisconsin, Dept Psychiat, Madison, WI 53706 USA
关键词
ipsilesional; contralesional; stroke; motor recovery; brain-computer interface; transcranial magnetic stimulation; TRANSCRANIAL MAGNETIC STIMULATION; MOTOR CORTEX EXCITABILITY; DOSE-RESPONSE RELATIONSHIPS; LESS-AFFECTED FORELIMB; UNAFFECTED HEMISPHERE; FUNCTIONAL RECOVERY; CORTICAL INFARCTS; CORTICOSPINAL TRACT; ACTIVATION BALANCE; MIRROR MOVEMENTS;
D O I
10.3389/fnhum.2017.00469
中图分类号
Q189 [神经科学];
学科分类号
071006 [神经生物学];
摘要
Following a stroke, the resulting lesion creates contralateral motor impairment and an interhemispheric imbalance involving hyperexcitability of the contralesional hemisphere. Neuronal reorganization may occur on both the ipsilesional and contralesional hemispheres during recovery to regain motor functionality and therefore bilateral activation for the hemiparetic side is often observed. Although ipsilesional hemispheric reorganization is traditionally thought to be most important for successful recovery, definitive conclusions into the role and importance of the contralesional motor cortex remain under debate. Through examining recent research in functional neuroimaging investigating motor cortex changes post-stroke, as well as brain-computer interface (BCI) and transcranial magnetic stimulation (TMS) therapies, this review attempts to clarify the contributions of each hemisphere toward recovery. Several functional magnetic resonance imaging studies suggest that continuation of contralesional hemisphere hyperexcitability correlates with lesser recovery, however a subset of well-recovered patients demonstrate contralesional motor activity and show decreased functional capability when the contralesional hemisphere is inhibited. BCI therapy may beneficially activate either the contralesional or ipsilesional hemisphere, depending on the study design, for chronic stroke patients who are otherwise at a functional plateau. Repetitive TMS used to excite the ipsilesional motor cortex or inhibit the contralesional hemisphere has shown promise in enhancing stroke patients' recovery.
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页数:9
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