Coupled rehabilitation protocols and neural plasticity: upper extremity improvements in chronic hemiparesis

Identifying effective rehabilitation interventions founded on sound theoretical and neurophysiological bases should decrease the prevalence of motor disabilities and chronic hemiparesis. This article addresses two theoretically sound behavioral interventions: (a) active neuromuscular stimulation on the impaired upper extremity and (b) coupled bilateral coordination training (i.e., mirrored movements on the less impaired limb combined with active stimulation on the impaired limb). The series of stroke motor recovery experiments currently reviewed clearly indicate that sensorimotor integration theory and bimanual coordination theory are viable candidates for directing behavioral rehabilitation approaches. Indeed, the reported evidence clearly supports activity dependent neural plasticity for progress toward stroke motor recovery.