The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review
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REVIEW ARTICLE
The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review Jingyi Wu 1,2
&
Hao Cheng 1,2 & Jiaqi Zhang 3
&
Zhongfei Bai 3,4 & Sufang Cai 1,2
Received: 19 November 2019 / Accepted: 22 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Objective To systematically review the modulatory effects of bilateral arm training (BAT) on the brain of stroke patients in contrast to unilateral arm training (UAT) or regular motor training. Methods We conducted a literature search using PubMed, EMBASE, MEDLINE, and Science Citation Index Expanded databases from the inception to March 2019 for identifying any relevant studies. Two authors independently screened the literature, extracted data, and qualitatively described the included studies. Results Eleven studies with a total of 225 stroke patients were included in this review. 156 out of those participants received neuroimaging or neurophysiological examinations. Six studies reported enhanced activation of the ipsilesional primary motor area (M1) induced by BAT, as measured by MEP and fMRI. Beyond the M1, three studies showed that supplementary motor area (SMA) was activated, and three studies found the primary sensory cortex area (S1) was activated by BAT in stroke patients, as measured by fMRI. One article showed that the inter-/intra-hemispheric functional connections of the sensorimotor network were more highly strengthened after BAT than regular motor training, in particular the functional connectivity between the SMA and the M1 in the bi-hemispheres. Three studies reported that BAT increased the inhibitory flow from the ipsilesional hemisphere to the contralesional hemisphere, as measured by interhemispheric transcallosal inhibition (IHI). However, the superiority of BAT in inducing a symmetric IHI than UAT was controversial. Conclusion BAT is potentially more effective than UAT in improving upper limb recovery after stroke by activating the ipsilesional primary motor area (M1), supplementary motor area (SMA), and primary sensory cortex (S1) and enhancing the intra-hemispheric and interhemispheric connectivity within the sensorimotor network and the cortical motor system. Keywords Stroke . Unilateral/bilateral arm training . Functional connectivity . Interhemispheric transcallosal inhibition
Introduction Human activity highly depends on the coordination and cooperation of the bilateral upper extremities. However, a stroke results in weakness on one side of the body, therefore leading * Sufang Cai [email protected] 1
Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
2
Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
3
The Hong Kong Polytechnic University, Hong Kong, China
4
Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
to physical disability and inability to perform mundane tasks [1, 2]. Successful
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