Evidence map›Paper›PMID 30805956›Full record

ArticleAnnals of neurology2019

Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation.

Jing Xu, Meret Branscheidt, Heidi Schambra, Levke Steiner, Mario Widmer, Jörn Diedrichsen, Jeff Goldsmith, Martin Lindquist, Tomoko Kitago, Andreas R Luft and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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  6. Quantitative measures of the resting EEG in stroke: a systematic review on clinical correlation and prognostic value.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2023
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  18. Network-oriented neurorehabilitation after stroke: a paradigmatic approach.Journal of neuroengineering and rehabilitation · 2026
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7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Jing XuDepartment of Neurology, Johns Hopkins University, Baltimore, MD.ORCID 0000-0003-0388-5046
Meret BranscheidtDepartment of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.
Heidi SchambraDepartment of Neurology, Columbia University, New York, NY.
Levke SteinerDepartment of Neurology, University of Zurich, Zurich, Switzerland.
Mario WidmerDepartment of Neurology, University of Zurich, Zurich, Switzerland.
Jörn DiedrichsenInstitute of Cognitive Neuroscience, University College London, London, United Kingdom.
Jeff GoldsmithDepartment of Biostatistics, Columbia University, New York, NY.
Martin LindquistDepartment of Biostatistics, Johns Hopkins University, Baltimore, MD.
Tomoko KitagoDepartment of Neurology, Columbia University, New York, NY.
Andreas R LuftDepartment of Neurology, University of Zurich, Zurich, Switzerland.
John W KrakauerDepartment of Neurology, Johns Hopkins University, Baltimore, MD.
Pablo A CelnikDepartment of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.
SMARTS Study Group

Funding

Novel Strategies to Enhance Motor Function After StrokeR01HD053793 · NICHD · JOHNS HOPKINS UNIVERSITY · PI CELNIK, PABLO ARIEL · 2007 to 2019
$5.2M
Understanding Motor Behavior After StrokeR01HD073147 · NICHD · JOHNS HOPKINS UNIVERSITY · PI CELNIK, PABLO ARIEL · 2012 to 2016
$1.7M
Quantitative Rehabilitation after StrokeK02NS104207 · NINDS · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI SCHAMBRA, HEIDI · 2017 to 2021
$1.1M
The neurophysiology of spontaneous biological recoveryK23NS078052 · NINDS · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI SCHAMBRA, HEIDI · 2012 to 2016
$934k
James S. McDonnell Foundation 220020220James S. McDonnell Foundation 90043345NICHD NIH HHS R01 HD053793NICHD NIH HHS R01 HD073147NINDS NIH HHS K02 NS104207NINDS NIH HHS K23 NS078052
6 · The paper itself

Abstract

objectivePatients with chronic stroke have been shown to have failure to release interhemispheric inhibition (IHI) from the intact to the damaged hemisphere before movement execution (premovement IHI). This inhibitory imbalance was found to correlate with poor motor performance in the chronic stage after stroke and has since become a target for therapeutic interventions. The logic of this approach, however, implies that abnormal premovement IHI is causal to poor behavioral outcome and should therefore be present early after stroke when motor impairment is at its worst. To test this idea, in a longitudinal study, we investigated interhemispheric interactions by tracking patients' premovement IHI for one year following stroke.

methodsWe assessed premovement IHI and motor behavior five times over a 1-year period after ischemic stroke in 22 patients and 11 healthy participants.

resultsWe found that premovement IHI was normal during the acute/subacute period and only became abnormal at the chronic stage; specifically, release of IHI in movement preparation worsened as motor behavior improved. In addition, premovement IHI did not correlate with behavioral measures cross-sectionally, whereas the longitudinal emergence of abnormal premovement IHI from the acute to the chronic stage was inversely correlated with recovery of finger individuation.

interpretationThese results suggest that interhemispheric imbalance is not a cause of poor motor recovery, but instead might be the consequence of underlying recovery processes. These findings call into question the rehabilitation strategy of attempting to rebalance interhemispheric interactions in order to improve motor recovery after stroke. Ann Neurol 2019;85:502-513.

Indexed as

AdultAgedFemaleFollow-Up StudiesFunctional LateralityHumansLongitudinal StudiesMaleMiddle AgedNeurological RehabilitationReaction TimeRecovery of FunctionStrokeStroke RehabilitationTranscranial Magnetic StimulationYoung Adult

Identifiers

PMID30805956
PMCPMC7374229

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.