Functional implications of ipsilesional motor deficits after unilateral stroke

Wetter, Spencer; Poole, Janet L.; Haaland, Kathleen Y.

doi:10.1016/j.apmr.2004.08.009

Cited by 105 publications

(105 citation statements)

References 33 publications

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“…In fact, Healey et al described similar distinctions in dominant and nondominant arm use for a wide range of tasks across a large number of subjects [2]. The dynamic dominance model has recently been supported in studies of righthanded stroke patients that reveal deficits in the ipsilesional arm, the quality of which tend to vary with the side of the lesion [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The ipsilesional arm of these patients tends to show deficits in trajectory control following lefthemisphere damage and positional control following righthemisphere damage.…”

Section: Introductionmentioning

confidence: 89%

“…In addition, significant ipsilesional deficits in movement coordination and accuracy have been revealed with the use of motion capture systems [3,[10][11][12]15,17]. Some studies that measured functional deficits have shown symmetric patterns that do not vary with lesion side [4,14,17]. However, Wetter et al have recently shown that while deficiencies in functional performance tests can be similar for patients with right-and left-hemisphere damage, this pattern can result from differences in the underlying dysfunction [14].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, both animal studies [18][19][20] and human studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] have revealed that unilateral brain damage can produce significant ipsilesional motor deficits. Studies in chronic stroke patients have reported performance deficiencies on the Purdue Pegboard Test [21], the JebsenTaylor Hand Function Test [22], as well as other tests that simulate activities of daily living (ADL) [4,10,[13][14]. In addition, significant ipsilesional deficits in movement coordination and accuracy have been revealed with the use of motion capture systems [3,[10][11][12]15,17].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies that measured functional deficits have shown symmetric patterns that do not vary with lesion side [4,14,17]. However, Wetter et al have recently shown that while deficiencies in functional performance tests can be similar for patients with right-and left-hemisphere damage, this pattern can result from differences in the underlying dysfunction [14]. For example, performance on a task, such as the simulated feeding task on the JebsenTaylor Hand Function Test, might be impaired by deficits in velocity control for left-hemisphere lesions and in accuracy control for right-hemisphere lesions.…”

Section: Introductionmentioning

confidence: 99%

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Does motor lateralization have implications for stroke rehabilitation?

Sainburg

Duff

2006

JRRD

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Abstract-Recent findings on motor lateralization have revealed consistent differences in the control strategies of the dominant and nondominant hemisphere/limb systems that could have implications for hemiplegic stroke patients. Studies in stroke patients have demonstrated deficiencies in the ipsilesional arm that reflect these distinctions; patients with right-hemisphere damage tend to show deficits in positional accuracy, and patients with left-hemisphere damage show deficits in trajectory control. Such deficits have been shown to impede functional performance; yet patients with severe dominant-side hemiplegia must often use the nondominant arm as the primary manipulator for activities of daily living. Nevertheless, the nondominant arm may not spontaneously become efficient as a dominant manipulator, as indicated by the persistence of deficits in chronic stroke patients. More research is necessary to determine whether motor therapy can facilitate a more effective transition of this arm from a nondominant to a dominant controller.

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Does motor lateralization have implications for stroke rehabilitation?

Sainburg

Duff

2006

JRRD

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“…There is considerable evidence that the ipsilateral hemisphere contributes to the control of normal voluntary movements (e.g., Kristeva et al 1991;Cramer et al 1999;Verstynen et al 2005) and that unilateral lesions following stroke result in deficits in movement control on the ipsilesional side (Wetter et al 2005;Schaefer et al 2007). However, utilization of the ipsilateral pathway may come at the expense of independent joint control, which limits the functional usage of the paretic upper extremity.…”

Section: Clinical Correlatesmentioning

confidence: 99%

Ipsilateral versus contralateral cortical motor projections to a shoulder adductor in chronic hemiparetic stroke: implications for the expression of arm synergies

et al. 2007

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An increase in ipsilateral descending motor pathway activity has been reported following hemiparetic stroke. In axial muscles, increased ipsilateral cortical activity has been correlated with good recovery whereas in distal arm muscles it is correlated with poor recovery. Currently, little is known about the control of proximal upper limb muscles following stroke. This muscle group is less impaired than the distal arm muscles following stroke, yet contributes to the abnormal motor coordination patterns associated with movements of the arm which can severely impair reaching ability. This study used transcranial magnetic stimulation (TMS) to evaluate the presence and magnitude of ipsilateral and contralateral projections to the pectoralis major (PMJ) muscle in stroke survivors. A laterality index (LI) was used to investigate the relationship between ipsilateral and contralateral projections and strength, clinical impairment level, and the degree of abnormal coordination expressed in the arm. The ipsilateral and contralateral hemispheres were stimulated using 90% TMS intensity while the subject generated shoulder adduction torques in both arms. Motor evoked potentials (MEPs) were measured in the paretic and non-paretic PMJ. The secondary torque at the elbow was measured during maximal adduction as an indicator of the degree of extensor synergy. Ipsilateral MEPs were most common in stroke survivors with moderate to severe motor deficits. The LI was correlated with clinical impairment level (P = 0.05) and the degree of extension synergy expressed in the arm (P = 0.03). The LI was not correlated with strength. These results suggest that increased excitability of ipsilateral pathways projecting to the proximal upper arm may contribute to the expression of the Correspondence to: Susan Schwerin, sc.schwerin@yahoo.com. extension synergy following stroke. These findings are discussed in relation to a possible unmasking or upregulation of oligosynaptic cortico-bulbospinal pathways following stroke. NIH Public Access

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Dynamic brain structural changes after left hemisphere subcortical stroke

Fan

Zhu

Chen

et al. 2012

Human Brain Mapping

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This study aimed to quantify dynamic structural changes in the brain after subcortical stroke and identify brain areas that contribute to motor recovery of affected limbs. High‐resolution structural MRI and neurological examinations were conducted at five consecutive time points during the year following stroke in 10 patients with left hemisphere subcortical infarctions involving motor pathways. Gray matter volume (GMV) was calculated using an optimized voxel‐based morphometry technique, and dynamic changes in GMV were evaluated using a mixed‐effects model. After stroke, GMV was decreased bilaterally in brain areas that directly or indirectly connected with lesions, which suggests the presence of regional damage in these “healthy” brain tissues in stroke patients. Moreover, the GMVs of these brain areas were not correlated with the Motricity Index (MI) scores when controlling for time intervals after stroke, which indicates that these structural changes may reflect an independent process (such as axonal degeneration) but cannot affect the improvement of motor function. In contrast, the GMV was increased in several brain areas associated with motor and cognitive functions after stroke. When controlling for time intervals after stroke, only the GMVs in the cognitive‐related brain areas (hippocampus and precuneus) were positively correlated with MI scores, which suggests that the structural reorganization in cognitive‐related brain areas may facilitate the recovery of motor function. However, considering the small sample size of this study, further studies are needed to clarify the exact relationships between structural changes and recovery of motor function in stroke patients. Hum Brain Mapp, 2013. © 2012 Wiley Periodicals, Inc.

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Functional implications of ipsilesional motor deficits after unilateral stroke

Cited by 105 publications

References 33 publications

Does motor lateralization have implications for stroke rehabilitation?

Does motor lateralization have implications for stroke rehabilitation?

Ipsilateral versus contralateral cortical motor projections to a shoulder adductor in chronic hemiparetic stroke: implications for the expression of arm synergies

Dynamic brain structural changes after left hemisphere subcortical stroke

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