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. 2023 Aug 3:14:1225924.
doi: 10.3389/fneur.2023.1225924. eCollection 2023.

Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice

Auwal Abdullahi  1 , Thomson W L Wong  1 , Shamay S M Ng  1
Affiliations

Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice

Auwal Abdullahi et al. Front Neurol. .

Abstract

Background: Stroke results in impairment of motor function of both the upper and lower limbs. However, although it is debatable, motor function of the lower limb is believed to recover faster than that of the upper limb. The aim of this paper is to propose some hypotheses to explain the reasons for that, and discuss their implications for research and practice.

Method: We searched PubMED, Web of Science, Scopus, Embase and CENTRAL using the key words, stroke, cerebrovascular accident, upper extremity, lower extremity, and motor recovery for relevant literature.

Result: The search generated a total of 2,551 hits. However, out of this number, 51 duplicates were removed. Following review of the relevant literature, we proposed four hypotheses: natural instinct for walking hypothesis, bipedal locomotion hypothesis, central pattern generators (CPGs) hypothesis and role of spasticity hypothesis on the subject matter.

Conclusion: We opine that, what may eventually account for the difference, is the frequency of use of the affected limb or intensity of the rehabilitation intervention. This is because, from the above hypotheses, the lower limb seems to be used more frequently. When limbs are used frequently, this will result in use-dependent plasticity and eventual recovery. Thus, rehabilitation techniques that involve high repetitive tasks practice such as robotic rehabilitation, Wii gaming and constraint induced movement therapy should be used during upper limb rehabilitation.

Keywords: bipedal locomotion hypothesis; central pattern generators hypothesis; lower extremity; motor recovery; natural instinct for walking hypothesis; role of spasticity hypothesis; stroke; upper extremity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the mechanism of natural instinct for walking hypothesis.
Figure 2
Figure 2
Schematic representation of the mechanism of bipedal locomotion hypothesis.
Figure 3
Figure 3
Schematic representation of the mechanism of central pattern generators hypothesis.
See this image and copyright information in PMC

References

    1. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. (2009) 8:741–54. doi: 10.1016/S1474-4422(09)70150-4 - DOI - PubMed
    1. Morris JH, Van Wijck F, Joice S, Donaghy M. Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction. Disabil Rehabil. (2013) 35:291–9. doi: 10.3109/09638288.2012.691942 - DOI - PubMed
    1. Ekstrand E, Rylander L, Lexell J, Brogårdh C. Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study. BMC Neurol. (2016) 16:208–9. doi: 10.1186/s12883-016-0733-x, PMID: - DOI - PMC - PubMed
    1. Waddell KJ, Birkenmeier RL, Bland MD, Lang CE. An exploratory analysis of the self-reported goals of individuals with chronic upper-extremity paresis following stroke. Disabil Rehabil. (2016) 38:853–7. doi: 10.3109/09638288.2015.1062926, PMID: - DOI - PMC - PubMed
    1. Silva ESM, Pereira ND, Gianlorenço ACL, Camargo PR. The evaluation of non-use of the upper limb in chronic hemiparesis is influenced by the level of motor impairment and difficulty of the activities-proposal of a new version of the motor activity log. Physiother Theory Pract. (2019) 35:964–74. doi: 10.1080/09593985.2018.1460430, PMID: - DOI - PubMed

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