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Dear Owen, Sheila, and the rest of you Englishspeaking people, Thank you for taking an interest in my question. I apologise if I mistreated your language and expressed myself in a too conversational manner - it is quite hard for a foreigner to frame questions in a scientifically correct manner. This does not mean, however, that we lack all other skills too...but maybe I was only doing my second best - I´ll try again. You wrote: "a. Defining bilaterally innervated for us all please? b. How & when did this observation arise? Cadavers - how many? MRI's? PET? c. How does a bilaterally innervated pectoralis 'explain' an adducted/IR UL early? Is this related purely to hemiplegia, brain injury or other allied syndromes? d. I presume we are talking about the unilateral innervation being the motor point for skeletal muscles in the limb? What would Carr & Sheppard (or indeed your goodself!) define as lesser quality? Inability to complete a motor plan in the expected time? Poor proximal stabilisation? Functionally inept? Poor TELER score? Barthel's? Rivermead? Here is my reply. a. "Muscles that are often used simultaneously on both sides of the body, like the muscles of the back and the abdomen, can be relatively easily activated on both sides (bilaterally) by stimulation of the MI (primary motor area, cortex) of one side. Movements of the fingers, however, can only be evoked on the opposite (contralateral) side by stimulation of the MI, which reflects that the fingers are used independently and usually differently on the two sides. The anatomic basis of this is the complete crossing of the pyramidal tract fibers controlling distal muscles." (The Central Nervous System, Structure and Function, Per Brodal, 1992) b. This is what I would like to know too for the reason of getting access to more exact knowledge c. This is all related to brain damage, be it of traumatic or cerebrovascular origin, but with a hemiparesis as a consequence. In my experience (I became a PT in 1966 and I have worked according to principles by Knott and Voss, Bobath, Brunnström and over the last years , motor relearning and motor control research as presented through Movement Science) the return of muscular activity usually happens first proximally, be it increased tone or voluntarily controlled movement. "Bilateral innervation" explains one of the reasons why to me, in a simple way, and I like simple explanations that take away the mystery that used to be around treatment of stroke. d. Mea culpa - sloppy language. Bilateral innervation ought to create stronger innervation and a larger number of active motor units=better quality, stronger muscle, possibly better movement control. Unilateral innervation=the opposite? Well, Mr Snidey, maybe you do know best. I certainly do not but I am trying to learn more every day. What I have learnt so far has made me leave Mme Bobath (and NDT for that matter) behind, and I do not believe that I, as a PT, can change increased tone or "spasticity" in any permanent way. I do, however, firmly believe in avoiding shortening of muscles and decreasing ROM, I happily give my patients intensive strengthening exercises where and when I think it is needed, I am very concerned about task-related exercises and goal orientation, all focused around the patient and his/her personal needs and possibilities. And, as far as I know from evidens today, there is no reason, exept the usual cardiovascular ones, not to send CVA patients to the gym - if they want to. I am a clinician, I work with my acute and subacute strokepatients every day for 2 - 4 months. I have no letters after my name except PT and I have no intention of adding any. PT:s like me should be allowed to ask silly questions on this list and thereby increase their knowledge through discussion with learned colleagues (as well as through reading literature) without getting snotty remarks in return. So there! Bodil Sweden Bodil Sweden %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%