Effects of Cross-Education on Neural Adaptations Following Non-Paretic Limb Training in Stroke: A Scoping Review with Implications for Neurorehabilitation

Abstract

Current stroke rehabilitation interventions focus on intensive task specific training of the paretic limb, which may not be feasible for individuals with higher levels of impairment or in the early phase of stroke. Cross-education, a mechanism that improves strength or skill of the untrained limb following unilateral motor training, has high clinical relevance for stroke rehabilitation. Despite its potential benefits, our knowledge on the application and efficacy of cross-education in stroke is limited. We performed a scoping review to synthesize the current evidence regarding neurophysiological and motor effects of cross-education training in stroke. Low to strong evidence from five studies demonstrated strength gains ranging from 31–200% in the untrained paretic limb following non-paretic muscle training. Neurophysiological mechanisms underlying cross-education were unclear as the three studies that used transcranial magnetic stimulation to probe functional connectivity demonstrated mixed results in low sample size. Our review suggests that cross-education is a promising clinical approach in stroke, however high quality studies focusing on neurophysiological mechanisms are required to establish the efficacy and underlying mechanisms of cross-education in stroke. Recommendations regarding future directions and clinical utility are provided.

Keywords:

• cross-education
• neuroplasticity
• stroke
• transcranial magnetic stimulation

Disclosure statement

The authors report no conflicts of interest.

Sources of support

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding

The author(s) reported there is no funding associated with the work featured in this article. This study was partly funded by the American Heart Association (AHA) Predoctoral Fellowship 829816 (HL) and the National Institute of Health (NIH) R01HD075777 (SM).