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The Role of Skill versus Use in the Recovery of Motor Function after Stroke

Skilled motor behaviors are accomplished through the coordinated activity of several sensory and motor structures that are widely distributed across the cerebral cortex. A major neuroscientific advance over the past 20 years has been the recognition that these cortical structures are functionally and structurally plastic throughout life. Remarkably, as new motor skills are learned, cortical neurons alter their response properties, creating a new functional topography. Likewise, after the cerebral cortex is injured, as might occur in stroke, the remaining cortical tissue alters its function based on post-injury behavioral experience. These new findings from both animal model and human neuroimaging studies have important implications for the design of rehabilitation strategies after brain injury. In this review, the author provides an overview of standard motor learning paradigms, the cortical structures involved in the motor learning process, and the evidence for plasticity in the cerebral cortex of both normal and injured brains.