Title: What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke?
Authors: Mindy F. Levin, Jeffrey A. Kleim, and Steven L. Wolf
Journal: Neurorehabilitation and Neural Repair, Vol. 23, No. 4, 313-319 (2009)

Abstract:

There is a lack of consistency among researchers and clinicians in the use of terminology that describes changes in motor ability following neurological injury. Specifically, the terms and definitions of motor compensation and motor recovery have been used in different ways, which is a potential barrier to interdisciplinary communication. This Point of View describes the problem and offers a solution in the form of definitions of compensation and recovery at the neuronal, motor performance, and functional levels within the framework of the International Classification of Functioning model.


Few Keys Points worth mentioning:

Both recovery and compensation can be defined at three levels of ICF Model (World Health Organization International Classification of Functioning)

Level ICF: Health Condition (Neuronal Level)

Recovery: Restoring function in neural tissue that was initially lost after injury. May be seen as reactivation in brain areas previously inactivated by the circulatory event. Although this is not expected to occur in the area of the primary brain lesion, it may occur in areas surrounding the lesion (penumbra) and in the diaschisis.

Compensation: Neural tissue acquires a function that it did not have prior to injury. May be seen as activation in alternative brain areas not normally observed in nondisabled individuals.

Level ICF: Body Functions/Structure (Performance Level)

Recovery: Restoring the ability to perform a movement in the same manner as it was performed before injury. This may occur through the reappearance of premorbid movement patterns during task accomplishment (voluntary joint range of motion, temporal and spatial interjoint coordination, etc).

Compensation: Performing an old movement in a new manner. May be seen as the appearance of alternative movement patterns (ie, recruitment of additional or different degrees of freedom, changes in muscle activation patterns such as increased agonist/antagonist coactivation, delays in timing between movements of adjacent joints, etc) during the accomplishment of a task.

Level ICF: Activity (Functional Level)

Recovery: Successful task accomplishment using limbs or end effectors typically used by nondisabled individuals.

Compensation: Successful task accomplishment using alternate limbs or end effectors. For example, opening a package of chips using 1 hand and the mouth instead of 2 hands.