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Abstract
Stroke is the second commonest cause of death and the principal cause of adult disability in the world (Pablo et al 2007). Stroke is also a major cause of prolonged neurologic disability in adults (Naidech et al., 2003; Zweifler, 2003), with an annual economic burden of nearly $45 billion in the United States (Smith et al., 2001). Stroke burden is likely to increase as a result of ageing and population growth if action is not taken now to remove or reduce the well-established determinants of stroke (Valery, 2007). In fact, extrapolation of the current data predicts that the mortality rate from stroke will double by 2020 (Warlow et al., 2003).
Fortunately the brain is ‘plastic’ and able to reorganize itself up to a certain degree of damage. Many studies have documented the changes in cortical organization that occur after motor stroke, particularly on the side of the lesion (Ward and Cohen, 2004). In addition, there is a balance of function between the two hemispheres that is controlled by interhemispheric inhibition. The stroke-affected hemisphere can be doubly disabled, by the stroke itself and by an imbalanced inhibition from the non-stroke hemisphere. In this model, increased activity in the affected hemisphere will promote recovery of the paretic limbs, as well as decreased inhibition from the non-stroke hemisphere (Jean-Pascal and khedr, 2007).