Post-Stroke Rehabilitation: Neurophysiology Processes of Bilateral Movement Training and Interlimb Coupling—A Systematic Review

: This systematic review explores the neurophysiological principles underlying bilateral movement training (BMT) and interlimb coupling in post-stroke rehabilitation. A 10-year literature search yielded 199 studies, of which 28 met inclusion criteria for detailed analysis. These studies examined the effectiveness of BMT in enhancing motor recovery, promoting neuroplasticity, and improving functional outcomes. Interventions such as task-specific and rhythmic exercises, robotic assistance, sensory enhancement, and virtual reality were highlighted for their ability to address the complexities of motor recovery. The review underscores the role of neurophysiological mechanisms, including central pattern generators (CPGs), interhemispheric coupling, and cortical disinhibition, in facilitating functional improvements. Evidence shows that high-intensity BMT provides significant gains for individuals with moderate to severe impairments, while low-intensity training benefits early recovery stages or those with limited capacity. Despite short-term successes, these improvements’ sustainability and impact on long-term functional independence remain underexplored. Key gaps include a limited understanding of individualized responses to BMT, insufficient research on combined upper and lower limb training, and minimal integration of advanced technologies like robotics and virtual reality. Additionally, the psychosocial dimensions of rehabilitation, such as emotional well-being and patient engagement, are often overlooked despite their critical influence on recovery outcomes. This review advocates a paradigm shift towards personalized, evidence-based rehabilitation strategies that address these gaps. Stroke rehabilitation can achieve improved outcomes by leveraging the neurophysiological mechanisms of BMT and interlimb coupling and incorporating advanced tools and patient-centered approaches. Future research should prioritize longitudinal studies, technology integration, and stratified interventions tailored to individual needs to optimize neuroplasticity and enhance the quality of life for stroke survivors.