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Abstract
Stroke is the leading cause of long term disability worldwide and a condition for which there is no universally accepted treatment (Ward et al., 2003a). The development of new effective therapeutic strategies relies on a better understanding of the mechanisms underlying recovery of function. Noninvasive techniques to study brain function, including functional magnetic resonance imaging, positron emission tomography (Fridman et al., 2004), transcranial magnetic stimulation, electroencephalography, and magnetoencephalography (Johansen-Berg et al., 2002a), led to recent studies that identified some of these operating mechanisms, resulting in the formulation of novel approaches to motor rehabilitation (Ward and Cohen, 2004).
Various concepts of how to enhance beneficial plasticity and in turn improve recovery of function are emerging, but controlled clinical trials based on these concepts are still in their infancy (Ziemann, 2005). The two cerebral hemispheres are functionally coupled and balanced. The balance is maintained and controlled by mutual interhemispheric inhibition (Ward and Cohen, 2004). A unilateral lesion leads to disruption of this balance and release of the intact hemisphere while the interhemispheric inhibition from the intact to the affected motor cortex is abnormally maintained during movement of the paretic hand (Ziemann, 2005).