Kuipers Jan A, Hoffman Norman, Carrick Frederick R, Jemni Monèm
The Carrick Institute, Cape Canaveral, FL 32920, USA.
Centre for Mental Health Research, University of Cambridge, Cambridge CB2 1TN, UK.
J Clin Med. 2025 May 27;14(11):3757. doi: 10.3390/jcm14113757.
Bilateral movement training (BMT) and interlimb coupling have emerged as promising neurophysiologically-based rehabilitation approaches for stroke survivors. However, the underlying mechanisms and optimal implementation strategies remain incompletely understood. This systematic review explored the neurophysiological principles underlying BMT and interlimb coupling interventions that led to positive clinical post-stroke rehabilitation outcomes, focusing on identifying the most effective bilateral and interlimb movement strategies. A 10-year literature search (2014-2024) following PRISMA guidelines was conducted across PubMed, Cochrane, and Google Scholar databases using keywords including stroke rehabilitation, bilateral movement training, cross-education, interlimb coupling, and interlimb transfer. Studies were included if they involved human subjects, clinical trials, stroke survivors, and described bilateral training protocols. Data extraction focused on neurophysiological mechanisms, intervention characteristics, and clinical outcomes. Quality assessment was performed using validated methodological appraisal tools, including the Newcastle-Ottawa Scale and Cochrane RoB 2.0. Of 199 initially identified studies, 28 met inclusion criteria for detailed analysis. BMT demonstrated effectiveness in enhancing motor recovery by engaging neurophysiological mechanisms, including central pattern generators, interhemispheric coupling, and cortical disinhibition. High-intensity BMT provided significant gains for individuals with moderate to severe impairments, while low-intensity training benefited early recovery stages. Interventions incorporating task-specific exercises, robotic assistance, sensory enhancement, and virtual reality showed particular promise for addressing motor recovery complexities. However, significant research gaps were identified, including limited understanding of individualized responses to BMT, insufficient research on combined upper and lower limb training, and minimal integration of advanced technologies. BMT and interlimb coupling play critical roles in post-stroke rehabilitation by facilitating neural plasticity and interlimb coordination. Integrating robotic assistance, sensory enhancement, and virtual reality with BMT offers a robust framework for maximizing rehabilitation outcomes. Future research should prioritize longitudinal studies, personalized rehabilitation approaches, technology integration, and stratified interventions tailored to individual needs to optimize neuroplasticity and enhance quality of life for stroke survivors.
双侧运动训练（BMT）和肢体间耦合已成为针对中风幸存者的基于神经生理学的、有前景的康复方法。然而，其潜在机制和最佳实施策略仍未完全明确。本系统综述探讨了导致中风后康复取得积极临床效果的BMT和肢体间耦合干预措施背后的神经生理学原理，重点是确定最有效的双侧和肢体间运动策略。按照PRISMA指南进行了为期10年（2014 - 2024年）的文献检索，在PubMed、Cochrane和谷歌学术数据库中使用了包括中风康复、双侧运动训练、交叉教育、肢体间耦合和肢体间转移等关键词。如果研究涉及人类受试者、临床试验、中风幸存者且描述了双侧训练方案，则纳入研究。数据提取集中在神经生理机制、干预特征和临床结果。使用经过验证的方法学评估工具进行质量评估，包括纽卡斯尔 - 渥太华量表和Cochrane RoB 2.0。在最初识别的199项研究中，28项符合详细分析的纳入标准。BMT通过激活包括中枢模式发生器、半球间耦合和皮质去抑制在内的神经生理机制，在增强运动恢复方面显示出有效性。高强度BMT对中度至重度损伤个体有显著改善，而低强度训练有利于早期恢复阶段。结合特定任务练习、机器人辅助、感觉增强和虚拟现实的干预措施在解决运动恢复复杂性方面显示出特别的前景。然而，也发现了显著的研究空白，包括对BMT个体反应的理解有限、上肢和下肢联合训练的研究不足以及先进技术的整合极少。BMT和肢体间耦合通过促进神经可塑性和肢体间协调在中风后康复中发挥关键作用。将机器人辅助、感觉增强和虚拟现实与BMT相结合，为最大化康复效果提供了一个有力的框架。未来的研究应优先进行纵向研究、个性化康复方法、技术整合以及根据个体需求定制分层干预措施，以优化神经可塑性并提高中风幸存者的生活质量。
