Poststroke rehabilitation requires a thorough understanding of the neural mechanisms underlying motor function recovery. This chapter outlines these mechanisms and also discusses the corresponding rehabilitation strategies based on the functional characteristics of the brain. The main topics we discuss are as follows: Although ipsilateral brain region activity is inhibited when using the limbs under normal conditions, it is thought that a decrease in this inhibition and the subsequent increased ipsilateral brain area activity post-injury promote recovery in the damaged contralateral neural network. For optimal poststroke motor function recovery, it is important to normalize the resulting imbalance in brain activity. Therefore, increased corticomotor excitation in the injured hemisphere or decreased excitation in the non-injured hemisphere must be promoted. Rehabilitation strategies include reducing non-paretic limb somatosensory input to decrease excitation in the non-injured hemisphere, increasing paretic limb somatosensory input to increase excitation in the injured hemisphere, increasing excitation in the injured hemisphere through movement training of the paretic hand and anesthesia of the paretic upper arm, increasing excitation in the injured hemisphere, or reducing excitation in the non-injured hemisphere. Considering the functional characteristics of the primary motor area, during the early stages after stroke, it is important to increase the somatosensory input to the paralyzed side and combine mental practices using motor imagery.
Part of the book: New Insight into Cerebrovascular Diseases