# Binanual Movements and Chronic Stroke Rehabilitation: Looking Back and Looking Forward
## 5 Summary  
The current evidence on experience-dependent neural changes is becoming integrated in rehabilitation protocols focused on individuals in the chronic stroke stage of recovery (Figure 1). Indeed, accumulated findings on bimanual movements training indicate an effective and efficient intervention to address post-stroke motor dysfunctions. Practicing bimanual coordination movements improves the motor capabilities on the impaired side of the upper extremity. Specifically, four sets of evidence form a converging operations conclusion that bimanual coordination movement training treatments are positive: (a) a primer for a typical treatment protocol, which includes activating the muscles involved in the treatment before beginning the stroke protocol; (b) in conjunction with neuromuscular-triggered electrical stimulation; (c) while executing rhythmic alternating movements; and (d) robotic guided rehabilitation [20; 53; 115; 116; 117].  
Concerning the neural networks and brain areas involved in changing the severity of motor dysfunctions, science has made important advances in understanding the interactions among brain areas [118; 119; 120; 121]. However, exact details on the distributed neural networks connecting the cortical and subcortical brain areas active during voluntary motor actions are still being explored. Consistent with [PERSON]'s elegant discussion of the concept of working memory evolving with the addition of new empirical findings, neural plasticity and distributed networks interacting with various brain mechanisms are still evolving [122; 123].  
Together, the current empirical bimanual movement training findings present a persuasive alternative to unilateral rehabilitation post-stroke. The time has come to select bimanual coordination as a sound theoretical basis for making progress toward motor recovery post-stroke and abandon one arm protocols. Logical and convincing arguments on motor actions involved in planning and executing challenging bimanual movements, perhaps with an assistive device (e.g., neuromuscular electrical stimulation or robotic manipulandum) included in the intervention, will advance our understanding of effective and efficient interventions. Based on the accumulated evidence [54; 77; 86; 124; 125], chronic post-stroke individuals who are prescribed experience-dependent treatments that include bimanual coordinated movements will display fewer impaired motor actions.  
Granted, comprehensive post-stroke rehabilitation protocols with the explicit intention of making progress toward motor recovery should closely follow the guidelines recommended by the American Heart Association [32] as well as England's Queen Square Upper Limb Neurorehabilitation Program [126]. As [PERSON] and [PERSON] stated in 2005, the efficacy and effectiveness of post-stroke bimanual movement interventions will advance rapidly when groups of individuals are matched according to lesion location, lesion size, and impairment severity [50]. Individualized post-stroke rehabilitation prescriptions are steps in the right direction.  
Conceptualization, J.H.C. and N.K.; methodology, J.H.C. and N.K.; data curation, J.H.C. and N.K.; writing--original draft preparation, J.H.C. and N.K.; writing--review and editing, J.H.C. and N.K.; All authors have read and agreed to the published version of the manuscript.  
This research received no external funding.  
Not applicable.  
The authors declare no conflict of interest.