The way I like to think about it, without getting too technical, is to think about the affected side of the brain as being bullied by the unaffected side. The unaffected side increases the activation because the affected side is damaged and has decreased activation. The unaffected side starts to take over some control of the affected side, and what that looks like clinically is the affected arm and hand are weaker and do not function as well. Meanwhile, the unaffected arm and hand get stronger contributing to that learned non-use phenomenon. If we do bilateral activities, are we clinically using both arms and hands equally? By doing that, are we stimulating the unaffected side, the bully of the brain? Or is it better to do a unilateral task so that you can try to increase activation of the affected side? There is a lot of discussion. I do not know the right answer to that right now. A big controversy is that most of our everyday tasks require both hands and both arms to use. Is it really feasible and realistic to just use one hand? Hope that explained it well enough.
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Veronica T. Rowe, PhD, OTR/L
Veronica Rowe, PhD, OTR/L, is a tenured associate professor at Georgia State University in Atlanta, Georgia. She has been an OT for 29 years, during which time she worked clinically in various areas of adult care and has been involved with multiple large clinical research trials. She is also a Certified Brain Injury Specialist Trainer. She has spent the last 15 years teaching in OT schools and pursuing her research interests in adult neurorehabilitation after stroke or other brain injury. Her research is ongoing with multiple funded projects and resultant publications.
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