A dynamic systems approach to bimanual coordination in stroke: implications for rehabilitation and research

During the last 30 years, the dynamic systems approach to coordination patterns contributed to shed new lights on the principles governing interlimb coordination, its dynamics, and its neural basis, predominantly in healthy people. In the present paper, we aim to show how these concepts could provide a theoretical and a methodological framework to address bimanual coordination dysfunction and rehabilitation in stroke patients. Compared to conventional approaches to research and rehabilitation in stroke, the one proposed in this paper is original since it seeks to assess and improve the impaired limb through (and in) coordination tasks. We concretely envisage a number of implications of the "dynamic systems" view to understand the behavioral consequences of intrinsic asymmetries (due to central nervous system injury) on bimanual dynamics in stroke and to identify how to exploit the central nervous system plasticity and self-organizing properties for recovering more adaptive coordinated movements. We conclude that more interest should be accorded to bimanual coordination assessment and rehabilitation in stroke. In this respect, the dynamical systems approach provides interesting insights and valuable tools. Experimental and clinical studies are still needed in order to elaborate firm and founded guidelines for therapy.