Movement neuroscience foundations of neurorehabilitation

Research into the neural control of movement has elucidated important principles that can provide guidelines to rehabilitation professionals for enhancing recovery of motor function in stroke patients. In this chapter, we elaborate principles that have been derived from research on neural control of movement, including optimal control, impedance control, motor lateralization, and principles of motor learning. Research on optimal control has indicated that two major categories of cost contribute to motor planning: explicit tasklevel costs, such as movement accuracy and speed, and implicit costs, such as energy and movement variability. Impedance control refers to neural mechanisms that modulate rapid sensorimotor circuits, such as reflexes, in order to impede perturbations that cannot be anticipated prior to movement. Research on motor lateralization has indicated that different aspects of motor control have been specialized to the two cerebral hemispheres. This organization leads to hemisphere-specific motor deficits in both the ipsilesional and contralesional arms of stroke patients. Ipsilesional deficits increase with severity of contralesional impairment level and have a substantial effect on functional independence. Finally, motor learning research has indicated that different neural mechanisms underlie different aspects of motor learning, such as adaptation vs skill learning, and that learning different aspects of tasks can generalize across different coordinates. In this chapter, we discuss the neurobiological basis of these principles and elaborate the implications for designing and implementing occupational and physical therapy treatment for movement deficits in stroke patients.