Ipsilateral Pathway Research Articles

Selective activation of ipsilateral motor pathways in intact humans.

It has been proposed that ipsilateral motor pathways play a role in the control of ipsilateral movements and recovery of function after injury. However, the extent to which ipsilateral motor pathways are engaged in voluntary activity in intact humans remains largely unknown. Using transcranial magnetic stimulation over the arm representation of the primary motor cortex, we examined ipsilateral motor-evoked potentials (iMEPs) in a proximal arm muscle during increasing levels of unilateral and bilateral isometric force in a sitting position. We demonstrate that iMEP area and amplitude decreased during bilateral contraction of homonymous (elbow flexor) muscles and increased during bilateral contraction of heteronymous (elbow flexor and extensor) muscles compared with a unilateral contraction, regardless of the level of force tested. To further understand the neuronal inputs involved in the bilateral effects, we examined the contribution from neck afferents projecting onto ipsilateral motor pathways. Medial (away from the muscle tested) and lateral (toward the muscle tested) rotation of the head enhanced bilateral iMEP effects from homonymous and heteronymous muscles, respectively. In contrast, head flexion and extension exerted nonspecific bilateral effects on iMEPs. Intracortical inhibition, in the motor cortex where iMEPs originated, showed modulation compatible with the changes in iMEPs. We conclude that ipsilateral projections to proximal arm muscles can be selectively modulated by voluntary contraction of contralateral arm muscles, likely involving circuits mediating asymmetric tonic neck reflexes acting, at least in part, at the cortical level. The pattern of bilateral actions may represent a strategy to engage ipsilateral motor pathways in a motor behavior.

Distribution of GABAergic cells in the inferior colliculus that project to the thalamus

A GABAergic component has been identified in the projection from the inferior colliculus (IC) to the medial geniculate body (MG) in cats and rats. We sought to determine if this GABAergic pathway exists in guinea pig, a species widely used in auditory research. The guinea pig IC contains GABAergic cells, but their relative abundance in the IC and their relative contributions to tectothalamic projections are unknown. We identified GABAergic cells with immunochemistry for glutamic acid decarboxylase (GAD) and determined that ~21% of IC neurons are GABAergic. We then combined retrograde tracing with GAD immunohistochemistry to identify the GABAergic tectothalamic projection. Large injections of Fast Blue, red fluorescent beads or FluoroGold were deposited to include all subdivisions of the MG. The results demonstrate a GABAergic pathway from each IC subdivision to the ipsilateral MG. GABAergic cells constitute ~22% of this ipsilateral pathway. In addition, each subdivision of the IC had a GABAergic projection to the contralateral MG. Measured by number of tectothalamic cells, the contralateral projection is about 10% of the size of the ipsilateral projection. GABAergic cells constitute about 20% of the contralateral projection. In summary, the results demonstrate a tectothalamic projection in guinea pigs that originates in part from GABAergic cells that project ipsilaterally or contralaterally to the MG. The results show similarities to both rats and cats, and carry implications for the role of GABAergic tectothalamic projections vis-à-vis the presence (in cats) or near absence (in rats and guinea pigs) of GABAergic interneurons in the MG.

Réorganisation du cortex sensorimoteur dans le cadre de la paralysie cérébrale unilatérale : apports des neurosciences

Cerebral palsy (CP) is a non-progressive injury to the developing central nervous system and defines as permanent disorders of the development of movement and posture, causing activity limitation. This neurodevelopmental disorder may lead to spastic unilateral cerebral palsy after early unilateral brain lesions. Physical and rehabilitation medicine has a particular interest in the study of organization and reorganization of the sensorimotor cortex following early brain injury. From neuroscience standpoint, early brain lesions have been shown to induce substantial neural reorganization owing to the higher plasticity in the developing brain. Unilateral injuries either to the motor cortex or the corticospinal tract can lead to different patterns of reorganization of the sensorimotor cortex. Many patients develop ipsilateral corticospinal pathways to control the paretic hand with the non-lesioned hemisphere. This type of reorganization is often observed following unilateral periventricular brain lesions, which damage the corticospinal tracts in the periventricular white matter. In this group of patients, the primary motor cortex has been found to be represented in the non-lesioned precentral gyrus ipsilateral to the paretic side. Inversely, in patients with perinatal unilateral middle cerebral artery stroke, primary motor cortex remains organised in the lesioned precentral gyrus contralateral to the paretic hand. However, regardless of these inter- or intrahemispheric motor representations, the primary somatosensory cortex representation remains in the lesioned hemisphere in both groups. These two types of corticospinal reorganization could influence the efficacy of rehabilitation.

Disappearance of unaffected motor cortex activation by repetitive transcranial magnetic stimulation in a patient with cerebral infarct.

The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the motor recovery mechanisms following stroke (Jang, 2011). Because stroke patients who had shown recovery by this mechanism usually showed poorer motor function, compared with patients who showed recovery by other mechanisms, several researchers have considered this mechanism as a maladaptive plasticity (Jang, 2013).

Motor Impairment Factors Related to Brain Injury Timing in Early Hemiparesis, Part I

Background. Extensive neuromotor development occurs early in human life, but the time that a brain injury occurs during development has not been rigorously studied when quantifying motor impairments. Objective. This study investigated the impact of timing of brain injury on the magnitude and distribution of weakness in the paretic arm of individuals with childhood-onset hemiparesis. Methods. A total of 24 individuals with hemiparesis were divided into time periods of injury before birth (PRE-natal, n = 8), around the time of birth (PERI-natal, n = 8), or after 6 months of age (POST-natal, n = 8). They, along with 8 typically developing peers, participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks using a multiple-degree-of-freedom load cell to quantify torques in 10 directions. A mixed-model ANOVA was used to determine the effect of group and task on a calculated relative weakness ratio between arms. Results. There was a significant effect of both time of injury group (P < .001) and joint torque direction (P < .001) on the relative weakness of the paretic arm. Distal joints were more affected compared with proximal joints, especially in the POST-natal group. Conclusions. The distribution of weakness provides evidence for the relative preservation of ipsilateral corticospinal motor pathways to the paretic limb in those individuals injured earlier, whereas those who sustained later injury may rely more on indirect ipsilateral corticobulbospinal projections during the generation of torques with the paretic arm.

Motor Impairments Related to Brain Injury Timing in Early Hemiparesis. Part II

Background. Extensive neuromotor development occurs early in human life, and the timing of brain injury may affect the resulting motor impairment. In Part I of this series, it was demonstrated that the distribution of weakness in the upper extremity depended on the timing of brain injury in individuals with childhood-onset hemiparesis. Objective. The goal of this study was to characterize how timing of brain injury affects joint torque synergies, or losses of independent joint control. Method. Twenty-four individuals with hemiparesis were divided into 3 groups based on the timing of their injury: before birth (PRE-natal, n = 8), around the time of birth (PERI-natal, n = 8), and after 6 months of age (POST-natal, n = 8). Individuals with hemiparesis and 8 typically developing peers participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks while their efforts were recorded by a multiple degree-of-freedom load cell. Motor output in 4 joints of the upper extremity was concurrently measured during 8 primary torque generation tasks to quantify joint torque synergies. Results. There were a number of significant coupling patterns identified in individuals with hemiparesis that differed from the typically developing group. POST-natal differences were most noted in the coupling of shoulder abductors with elbow, wrist, and finger flexors, while the PRE-natal group demonstrated significant distal joint coupling with elbow flexion. Conclusion. The torque synergies measured provide indirect evidence for the use of bulbospinal pathways in the POST-natal group, while those with earlier injury may use relatively preserved ipsilateral corticospinal motor pathways.

Binaural hearing ability with mastoid applied bilateral bone conduction stimulation in normal hearing subjects

The ability to use binaural cues when stimulation was by bilaterally applied bone conduction (BC) transducers was investigated in 20 normal hearing participants. The results with BC stimulation were compared with normal air conduction (AC) stimulation through earphones. The binaural hearing ability was tested by spatial release from masking, binaural intelligibility level difference (BILD), binaural masking level difference (BMLD) using chirp stimulation, and test of the precedence effect. In all tests, the participants revealed a benefit of bilateral BC stimulation indicating use of binaural cues. In the speech based tests, the binaural benefit for BC stimulation was approximately half that with AC stimulation. For the BC BMLD test with chirp stimulation, there were indications of superposition of the ipsilateral and contralateral pathways at the cochlear level affecting the results. The precedence effect test indicated significantly worse results for BC stimulation than for AC stimulation with low-frequency stimulation while they were close for high-frequency stimulation; broad-band stimulation gave results that were slightly worse than the high-frequency results.

Functional role of left PMd and left M1 during preparation and execution of left hand movements in older adults

A disruptive transcranial magnetic stimulation (TMS) approach was used to determine whether the increased frontal activation and reduced hemispheric laterality brain activation patterns observed in older adults during motor tasks play a functional role. Young and older adults abducted their left index finger as soon as possible after a visual imperative signal presented 500 ms after a warning signal. TMS was applied to the dorsal premotor (PMd) or primary motor (M1) cortex in the left or right hemisphere at seven times during response preparation and execution. Both groups exhibited faster reaction times in their left hand after stimulation of the left PMd (i.e., ipsilateral to the responding hand) relative to trials with no TMS, indicating a functional role of the left PMd in the regulation of impulse control. This result also suggests that the function of the left PMd appears to be unaffected by the healthy aging process. Right M1 TMS resulted in a response time delay in both groups. Only for older adults did left M1 stimulation delay responses, suggesting the involvement of ipsilateral motor pathways in the preparation of motor actions in older adults.

Acute effect of callosotomy on cortical temporal coupling in humans: Intraoperative electrocorticographic recording

ObjectiveTo investigate the acute role of the corpus callosum in inter- and intrahemispheric temporal coupling. MethodsIntraoperative electrocorticography (ECoG) makes it possible to investigate the acute role of the corpus callosum in cortical temporal coupling, or synchrony, without additional surgical intervention, thus avoiding the confounding effects of scalp recordings and the long-term reorganization of functional connectivity. ECoGs were recorded in three patients during callosotomies. Bilateral electrode grids were placed over the frontal cortex. ECoGs were recorded immediately before and after performing the anterior two-thirds callosal transection, were digitalized at a sampling rate of 512Hz, inspected for artifacts, and later analyzed offline. Cross-correlation between inter- and intrahemispheric electrode pairs were obtained for 1Hz bins and special broad bands obtained by principal component analysis for each patient pre- and post-callosotomy. ResultsA statistically significant change was observed in intrahemispheric temporal coupling between electrode pairs that exceeded the confidence limit of correlation. ConclusionsPresent results show that interrupting the influence of the corpus callosum has an acute effect on intrahemispheric activity by decreasing temporal coupling between cortical areas. SignificanceIntrahemispheric temporal coupling does not depend exclusively on ipsilateral cortico-cortical pathways or on subcortical influences, but also on callosal pathways.

Deterioration of pre-existing hemiparesis due to injury of the ipsilateral anterior corticospinal tract

BackgroundThe anterior corticospinal tract (CST) has been suggested as one of the ipsilateral motor pathways, which contribute to motor recovery following stroke. In this study, we report on a patient who showed deterioration of pre-existing hemiparesis due to an injury of the ipsilateral anterior CST following a pontine infarct, as evaluated by diffusion tensor tractography (DTT).Case presentationA 55-year-old male patient showed quadriparesis after the onset of an infarct in the right pontine basis. He had history of an infarct in the left middle cerebral artery territory 7 years ago. Consequently, he showed right hemiparesis before onset of the right pontine infarct. Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed. The DTTs for whole CST of the right hemisphere in the patient and both hemispheres in control subjects descended through the known CST pathway. By contrast, the DTT for the left whole CST of the patient showed a complete injury finding. The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord. However, the DTT for right anterior CST in the patient showed discontinuation below the right pontine infarct.ConclusionIt appeared that the deterioration of the pre-existing right hemiparesis was ascribed to an injury of the right anterior CST due to the right pontine infarct.

The differential effects of acute right- vs. left-sided vestibular failure on brain metabolism

The human vestibular system is represented in the brain bilaterally, but it has functional asymmetries, i.e., a dominance of ipsilateral pathways and of the right hemisphere in right-handers. To determine if acute right- or left-sided unilateral vestibular neuritis (VN) is associated with differential patterns of brain metabolism in areas representing the vestibular network and the visual-vestibular interaction, patients with acute VN (right n = 9; left n = 13) underwent resting state (18)F-FDG PET once in the acute phase and once 3 months later after central vestibular compensation. The contrast acute vs. chronic phase showed signal differences in contralateral vestibular areas and the inverse contrast in visual cortex areas, both more pronounced in VN right. In VN left additional regions were found in the cerebellar hemispheres and vermis bilaterally, accentuated in severe cases. In general, signal changes appeared more pronounced in patients with more severe vestibular deficits. Acute phase PET data of patients compared to that of age-matched healthy controls disclosed similarities to these patterns, thus permitting the interpretation that the signal changes in vestibular temporo-parietal areas reflect signal increases, and in visual areas, signal decreases. These data imply that brain activity in the acute phase of right- and left-sided VN exhibits different compensatory patterns, i.e., the dominant ascending input is shifted from the ipsilateral to the contralateral pathways, presumably due to the missing ipsilateral vestibular input. The visual-vestibular interaction patterns were preserved, but were of different prominence in each hemisphere and more pronounced in patients with right-sided failure and more severe vestibular deficits.

The lateralization of gustatory function and the flow of information from tongue to cortex

Controversy surrounds whether crossed and/or uncrossed fibers carry taste information from tongue to cortex and whether there is hemispheric specialization for gustatory processing. The current study examined these issues in 14 patients with unilateral insula lesions, seven with right-sided and seven with left-sided damage, and in 42 healthy controls. Two tasks were carried out, with tastants applied unilaterally to the tongue tip: (1) taste discrimination; and (2) stimulus sampling followed by judgments of quality, intensity, hedonics and name-recognition, for sweet, salty, bitter and sour tastants. Controls were better at discriminating tastants applied to their right tongue tip relative to their left, and better at taste quality judgments when tastants were applied to their left tongue tip relative to their right. Insula lesions to the left or right side resulted in bilateral impairments in discrimination, quality judgments and naming, when compared to controls. However, the Left insula group was poorer on tasks involving salt, and for ipsilateral hedonic judgments, relative to controls and the Right insula group. These findings are consistent with gustatory information ascending from tongue to cortex both ipsilaterally and contralaterally, and provide preliminary support for hemispheric gustatory specialization.

Motor function-related maladaptive plasticity in stroke: A review

Brain plasticity can be classified as adaptive and maladaptive. Maladaptive plasticity indicates hindered functional recovery or the development of an unwanted symptom. Although a considerable amount is known about adaptive plasticity in stroke, relatively little is known of maladaptive plasticity. In the current study, previous studies on motor function-related maladaptive plasticity in stroke are reviewed in terms of compensatory movement pattern (CMP), delayed-onset involuntary abnormal movements (IAMs), and the ipsilateral motor pathway as a motor recovery mechanism. For successful stroke rehabilitation, it is important that the characteristics of maladaptive plasticity are accurately recognized. However, there is a lack of definitive evidence regarding the recognition of motor function-related maladaptive plasticity, although it seems that each of the three above-mentioned topics are involved. As for CMP, patients with a good neurological state as much as having a normal movement pattern, should be considered to have maladaptive plasticity, and in terms of the ipsilateral motor pathway, patients with bilateral innervations can be considered to have maladaptive plasticity. On the other hand, IAMs due to delayed neuronal degeneration should be ruled out in patients with delayed-onset IAMs. Therefore, for the accurate recognition of motor function-related maladaptive plasticity in stroke, a thorough evaluation of neurological state using brain mapping techniques is necessary, and subsequently, the prevention or intensive management of maladaptive plasticity is needed.

Ipsilateral Motor Pathways after Stroke: Implications for Non-Invasive Brain Stimulation

In humans the two cerebral hemispheres have essential roles in controlling the upper limb. The purpose of this article is to draw attention to the potential importance of ipsilateral descending pathways for functional recovery after stroke, and the use of non-invasive brain stimulation (NBS) protocols of the contralesional primary motor cortex (M1). Conventionally NBS is used to suppress contralesional M1, and to attenuate transcallosal inhibition onto the ipsilesional M1. There has been little consideration of the fact that contralesional M1 suppression may also reduce excitability of ipsilateral descending pathways that may be important for paretic upper limb control for some patients. One such ipsilateral pathway is the cortico-reticulo-propriospinal pathway (CRPP). In this review we outline a neurophysiological model to explain how contralesional M1 may gain control of the paretic arm via the CRPP. We conclude that the relative importance of the CRPP for motor control in individual patients must be considered before using NBS to suppress contralesional M1. Neurophysiological, neuroimaging, and clinical assessments can assist this decision making and facilitate the translation of NBS into the clinical setting.

The relevance of task-irrelevant sounds: hemispheric lateralization and interactions with task-relevant streams

The effect of unattended task-irrelevant auditory stimuli in the context of an auditory task is not well understood. Using human functional magnetic resonance imaging (fMRI) we compared blood oxygenation level dependent (BOLD) signal changes resulting from monotic task-irrelevant stimulation, monotic task-relevant stimulation and dichotic stimulation with an attended task-relevant stream to one ear and an unattended task-irrelevant stream to the other ear simultaneously. We found strong bilateral BOLD signal changes in the auditory cortex (AC) resulting from monotic stimulation in a passive listening condition. Consistent with previous work, these responses were largest on the side contralateral to stimulation. AC responses to the unattended (task-irrelevant) sounds were preferentially contralateral and strongest for the most difficult condition. Stronger bilateral AC responses occurred during monotic passive-listening than to an unattended stream presented in a dichotic condition, with attention focused on one ear. Additionally, the visual cortex showed negative responses compared to the baseline in all stimulus conditions including passive listening. Our results suggest that during dichotic listening, with attention focused on one ear, (1) the contralateral and the ipsilateral auditory pathways are suppressively interacting; and (2) cross-modal inhibition occurs during purely acoustic stimulation. These findings support the existence of response suppressions within and between modalities in the presence of competing interfering stimuli.

Neuronavigation-guided endoscopic and hodotopic approach to an arachnoid cyst

Background:Arachnoid cysts are intraarachnoid benign cystic lesions filled with cerebrospinal fluid and should be treated without incurring further morbidity to the patients.Case Description:The authors present a case of a 68-year-old elderly female with a large right fronto-parieto-temporal arachnoid cyst who has been suffering from mild left hemiparesis for the past 4 years and presented with sudden onset of seizures. The 3 Tesla MR system with diffusion tensor imaging (DTI) and MR tractography of the brain showed a large right fronto-parieto-temporal cystic lesion measuring 7 × 5 × 5 cm with a midline shift of 1 cm, suggestive of an arachnoid cyst with surrounding ipsilateral white matter projection pathways and inferior occipito-frontal fasciculus or inferior longitudinal white matter tracts. The cyst was successfully treated with neuronavigation-guided endoscopic and hodotopical approach to fenestrate the arachnoid cyst into the sylvian cistern, avoiding inadvertent injury to major white matter tracts portrayed by DTI. Postoperatively, a repeated computed tomography (CT) scan of the brain revealed a smaller arachnoid cyst with correction of the midline shift. The patient was weaned off from the ventilator and her hemiplegia improved gradually.Conclusion:This case report emphasizes the value of neuronavigation-guided endoscopic and hodotopic approach to fenestrate the intra-axial arachnoid cyst.

Behavioral consequences of unilateral inferior colliculus lesions in the rat

This study was carried out to determine the behavioral sensitivity to sound of rats with unilateral lesions of inferior colliculus (IC) located ipsilateral or contralateral to the projection pathway from one ear. Absolute thresholds for the detection of a broad-band noise burst were compared for rats with a profound conductive hearing loss in one ear and a lesion placed either ipsilateral or contralateral to the normally functioning ear. The rats were trained to make withdrawal responses to avoid a shock when they detected the presence of a noise burst. Sound pressure level was systematically lowered to obtain psychophysical curves from which absolute thresholds could be determined. Complete lesions of the contralateral IC resulted in substantial elevations in absolute threshold relative to normal whereas equivalent lesions of the ipsilateral IC produced relatively little elevation. In neither case did unilateral destruction of the IC produce a total inability to respond to sound. Contralateral IC lesions that included the dorsal nucleus of the lateral lemniscus (DNLL) produced a significantly greater elevation in behavioral thresholds than complete lesions limited to the IC. The results indicate a predominance of the contralateral over the ipsilateral pathway to IC for maintaining normal thresholds. They also indicate that other pathways that bypass the IC are likely involved in detecting the presence of a sound.

Ten-m3 Is Required for the Development of Topography in the Ipsilateral Retinocollicular Pathway

BackgroundThe alignment of ipsilaterally and contralaterally projecting retinal axons that view the same part of visual space is fundamental to binocular vision. While much progress has been made regarding the mechanisms which regulate contralateral topography, very little is known of the mechanisms which regulate the mapping of ipsilateral axons such that they align with their contralateral counterparts.ResultsUsing the advantageous model provided by the mouse retinocollicular pathway, we have performed anterograde tracing experiments which demonstrate that ipsilateral retinal axons begin to form terminal zones (TZs) in the superior colliculus (SC), within the first few postnatal days. These appear mature by postnatal day 11. Importantly, TZs formed by ipsilaterally-projecting retinal axons are spatially offset from those of contralaterally-projecting axons arising from the same retinotopic location from the outset. This pattern is consistent with that required for adult visuotopy. We further demonstrate that a member of the Ten-m/Odz/Teneurin family of homophilic transmembrane glycoproteins, Ten-m3, is an essential regulator of ipsilateral retinocollicular topography. Ten-m3 mRNA is expressed in a high-medial to low-lateral gradient in the developing SC. This corresponds topographically with its high-ventral to low-dorsal retinal gradient. In Ten-m3 knockout mice, contralateral ventrotemporal axons appropriately target rostromedial SC, whereas ipsilateral axons exhibit dramatic targeting errors along both the mediolateral and rostrocaudal axes of the SC, with a caudal shift of the primary TZ, as well as the formation of secondary, caudolaterally displaced TZs. In addition to these dramatic ipsilateral-specific mapping errors, both contralateral and ipsilateral retinocollicular TZs exhibit more subtle changes in morphology.ConclusionsWe conclude that important aspects of adult visuotopy are established via the differential sensitivity of ipsilateral and contralateral axons to intrinsic guidance cues. Further, we show that Ten-m3 plays a critical role in this process and is particularly important for the mapping of the ipsilateral retinocollicular pathway.

Foveational complexity in single word identification: Contralateral visual pathways are advantaged over ipsilateral pathways

Recognition of a single word is an elemental task in innumerable cognitive psychology experiments, but involves unexpected complexity. We test a controversial claim that the human fovea is vertically divided, with each half projecting to either the contralateral or ipsilateral hemisphere, thereby influencing foveal word recognition. We report a novel haploscope task: the two halves of a four-letter word were briefly presented to the two eyes in a Both condition (st|ep)(st|ep), a Contralateral condition (st|__)(__|ep), or an Ipsilateral condition (__|ep)(st|__), all yielding the same single word percept (step). The Both condition yielded superior perceptual recognition, followed by the contralateral projection, then the ipsilateral projection. These results demonstrate that the structure of the fovea influences even the recognition of short, foveally presented words. Projecting different parts of the same word to different hemispheres involves unforeseen complexities and opportunities for optimizing hemispheric coordination.

Neck rotation modulates flexion synergy torques, indicating an ipsilateral reticulospinal source for impairment in stroke

The effect of reticular formation excitability on maximum voluntary torque (MVT) generation and associated muscle activation at the shoulder and elbow was investigated through natural elicitation (active head rotation) of the asymmetric tonic neck reflex (ATNR) in 26 individuals with stroke and 9 age-range-matched controls. Isometric MVT generation at the shoulder and elbow was quantified with the head rotated (face pointing) contralateral and ipsilateral to the paretic (stroke) and dominant (control) arm. Given the dominance of abnormal torque coupling of elbow flexion with shoulder abduction (flexion synergy) in stroke and well-developed animal models demonstrating a linkage between reticular formation and ipsilateral elbow flexors and shoulder abductors, we hypothesized that constituent torques of flexion synergy, specifically elbow flexion and shoulder abduction, would increase with contralateral head rotation. The findings of this investigation support this hypothesis. Increases in MVT for three of four flexion synergy constituents (elbow flexion, shoulder abduction, and shoulder external rotation) were observed during contralateral head rotation only in individuals with stroke. Electromyographic data of the associated muscle coactivations were nonsignificant but are presented for consideration in light of a likely underpowered statistical design for this specific variable. This study not only provides evidence for the reemergence of ATNR following stroke but also indicates a common neuroanatomical link, namely, an increased reliance on ipsilateral reticulospinal pathways, as the likely mechanism underlying the expression of both ATNR and flexion synergy that results in the loss of independent joint control.