Abstract
Many studies in human and animal models have shown that neural plasticity compensates for the loss of motor function after stroke. However, neural plasticity concerning compensatory movement, activated ipsilateral motor projections and competitive interaction after stroke contributes to maladaptive plasticity, which negatively affects motor recovery. Compensatory movement on the less-affected side helps to perform self-sustaining activity but also creates an inappropriate movement pattern and ultimately limits the normal motor pattern. The activated ipsilateral motor projections after stroke are unable to sufficiently support the disruption of the corticospinal motor projections and induce the abnormal movement linked to poor motor ability. The competitive interaction between both hemispheres induces abnormal interhemispheric inhibition that weakens motor function in stroke patients. Moreover, widespread disinhibition increases the risk of competitive interaction between the hand and the proximal arm, which results in an incomplete motor recovery. To minimize this maladaptive plasticity, rehabilitation programs should be selected according to the motor impairment of stroke patients. Noninvasive brain stimulation might also be useful for correcting maladaptive plasticity after stroke. Here, we review the underlying mechanisms of maladaptive plasticity after stroke and propose rehabilitation approaches for appropriate cortical reorganization.
Highlights
For several decades, many studies in both human and animal models have demonstrated that neural plasticity can change the structure and/or the function of the central nervous system after stroke and rehabilitation [1,2,3]
This paper focuses on 4 factors that influence maladaptive plasticity in motor-related areas after stroke: (1) compensatory movement, (2) ipsilateral motor projections, (3) competitive interaction, and (4) rehabilitation and noninvasive brain stimulation
This paper focuses on the underlying mechanisms of maladaptive plasticity, which inhibits motor recovery after stroke, and the approaches that can be used to solve this problem
Summary
Many studies in both human and animal models have demonstrated that neural plasticity can change the structure and/or the function of the central nervous system after stroke and rehabilitation [1,2,3]. In addition to findings that neural plasticity aids in the acquisition of new skills and compensates for the loss of function [3, 5], it has been reported that injury and excessive training drive neural plasticity in a maladaptive direction [6, 7]. The extent of functional gains from neural plasticity on the motor recovery of normal patterns or the compensatory movements of new patterns and the effect of rehabilitation on these processes are unclear [23]. Part of this problem is derived from the confusion consensus on the role of neural plasticity in motor recovery and compensatory movement [11, 23]. The purpose of this paper was to provide a comprehensive overview of maladaptive plasticity after stroke to understand its mechanisms and suggest the approaches for appropriate cortical reorganization
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