Learning postural tasks in hemiparetic patients with lesions of left versus right hemisphere.

There are a number of studies concerning difference of postural control following left or right hemisphere lesions. Few studies, however, compare the role of the right and left hemisphere in learning new postural tasks. This study aimed to address this question. Twenty patients with hemiparesis after ischemic stroke in the middle cerebral artery territory (11 with a right and 9 with a left hemispheric lesion) were investigated. All subjects were trained using two different tasks during ten training sessions. In both tasks, the subjects stood on a force platform and were taught to change the position of the center of pressure (COP) presented as a cursor on a monitor screen in front of the patient. The subjects were instructed to align the COP with the target and then move the target by shifting the COP in the indicated direction. In the "Balls" task, the position of the target (a ball) varied randomly, so the subject had to learn a general strategy of voluntary COP control. In "Bricks", the subject always had to move the target in a single direction (downward) from the top to the bottom of the screen, so that a precise postural coordination had to be learned. The number of correctly performed trials for a session was scored. The task performance and its rate were analyzed and compared with respect to the lesion lateralization between two patient groups. The voluntary control of the COP position and learning course were initially impaired in all groups of patients in both tasks. In "Balls", there were no differences between the two groups of patients. In contrast, in "Bricks", there was a greater initial deficit in patients with right hemisphere lesions, while the rate of postural learning and the final performance level did not differ between the groups. With a lower initial deficit and similar rate of learning, the maximal level of the task performance was reached earlier (on the 5th day of training) in patients with left hemisphere lesions. This group stopped improving its performance during follow-up training. The results suggest that the motor structures of the right hemisphere are more involved in the precise control of COP trajectory, but not in learning. There is no difference between hemispheres in the initial performance and learning of the general strategy of voluntary COP control. Possibly, the control of specific COP trajectory needs more sensory feedback that is associated with greater involvement of the right hemisphere. This might be a reason for the greater initial impairment of this task after lesions in the right hemisphere.

Interhemispheric motor cortex influence during bimanual unloading.

Using the transcranial magnetic stimulation (TMS) of motor cortex we examined changes in the motor evoked potential (MEP) during natural bimanual unloading, during lifting of an equivalent weight by the contralateral arm while the ipsilateral forearm was held stationary (CONTRA) and during practice of unnatural unloading. During natural unloading, MEP amplitude decreased proportionally to the muscle activity. In CONTRA task MEP amplitude decreased, but the muscle activity was not changed. It suggests that the motor cortex activity related to the "postural" arm was inhibited by the contralateral motor cortex related to the "lifting" arm. This inhibition was diminished during the unloading task. When learning the unnatural unloading, the muscle activity decreased significantly with insignificant changes of MEP amplitude. Active role of the motor cortex during learning of the new task might be related to the reduction of the contralateral inhibition. This suggestion is supported by the observation that MEP amplitude decreased stronger than muscle activity in the first learning session similar to that in CONTRA task. MEP amplitude and background activity of the muscle proportionally decreased in the last learning trial. The results show that motor cortex activity in natural and unnatural unloading task might be related to the reduction of the interhemispheric inhibition.