Bimanual training after stroke: are two hands better than one?

Functional recovery of the paretic upper extremity eludes the majority of patients post stroke. Although many tasks require the coordinated participation of both hands, rehabilitation strategies for the most part have focused on the paretic limb. This article reviews the behavioral basis of bimanual coordination both in health and after stroke hemiparesis and reviews clinical research studies that have used a bimanual training protocol for rehabilitation. Our intent is to examine and evaluate the evidence for the application of such an approach to enhance recovery of upper extremity function. Based on our review, we suggest a set of prerequisite task features and patient characteristics for consideration in the application of bimanual training protocols for poststroke rehabilitation.