Laterality of motor control revisited: directionality of callosal traffic and its rehabilitative implications.

Based on evidence derived from personal data and a comprehensive review of the literature, this article provides a perspective of laterality of motor control in humans. The evidence supports existence of directionality in callosal traffic, codified in handedness. However, it is the neural handedness that definitively reveals the directionality of signal traffic between the executive and the minor hemisphere; the minor hemisphere is devoted to the affairs occurring on or toward the nondominant side of the body. Thus, moving the nondominant side of the body (and sensing from it) are bi-hemispherical events that require callosal participation. Time-resolved data are provided that indicate the absence of any ipsilateral corticospinal tract innervation in humans. The rehabilitative aspects of the new circuitry (i.e., one-way callosal traffic scheme) is reviewed, establishing that previously described plasticity or reorganization of cortical structure was a reflection of the newly described anatomy underpinning handedness. The distinction between neural and behavioral handedness is emphasized, suggesting simple and robust ways to establish a person's handedness without resorting to invasive and inconclusive tests currently in vogue. In the past, lack of knowledge of directionality in callosal traffic has resulted in surgical removal of healthy hemispheres (including the major hemisphere) in futile attempts to stop epilepsy in those with an intractable condition. Evidence is provided for lack of any motor communication from the minor to the major hemisphere, which makes the minor hemisphere incapable of initiating and propagating seizures.