Functional magnetic resonance ging was used to map the hand sensorimotor area of hemiparetic adolescents and young adults who had suffered unilateral brain damage in the perinatal period. Unlike normal subjects, who exhibit cortical activation primarily contralateral to voluntary finger movements, the hemaretic patients' intact hemispheres were equally activated by contralateral and ipsilateral finger movements. Our fidings are consistent with previous clinical observations and animal experiments which suggest that the immature brain is able to reorganize in response to focal injury.Many observations suggest that the immature human brain is characterized by "plasticity": i.e., it is capable of major functional reorganization in response to external and internal stimuli. For example, children will recover language skills after sustaining a large insult or even hemispherectomy on the speech-dominant side if the damage occurs before age 7 or 8 (1). Similarly, if a child with strabismus is forced to use the squinting eye by patching of the good eye before about age 7, permanent visual loss in the squinting eye (amblyopia) can be prevented (2, 3). The sensorimotor system also demonstrates plasticity. Children with large unilateral brain lesions can learn to reach out and grasp an object and can walk, although with a limp (4). Movements of the paretic hand in these children are often accompanied by "mirror" movements on the opposite side (5, 6). Such parallel movements are much more prominent when brain injury occurs before 1 year of age (6). These observations suggest that motor function might be represented in the hemisphere ipsilateral to the weak hand if injury is incurred early in life.Similar effects have been found in animal models: e.g., the reaction of the rodent motor system to postnatal hemispherectomy. In this model, it has been shown that the remaining hemisphere develops a new, uncrossed corticospinal tract to the ipsilateral spinal cord in addition to the usual crossed one (7). Huttenlocher et al. (8,9) have succeeded in making separate cortical maps of the neurons forming the aberrant (uncrossed) and normal (crossed) tracts. The neurons which are "recruited" to form the uncrossed tract are found in the same areas as the usual "crossed" neurons, as well as in the adjacent cortex. Thus, these cortical mapping experiments suggest that a limited population of multipotential neurons might be involved in brain plasticity. The mechanisms of neural reorganization in the human brain are not well understood (10) but may involve the unmasking of existing pathways (11, 12), competition for synaptic space (13), or axonal migration and sprouting along chemical gradients (14).Although ample clinical observations (1-7) and animal experiments (8,9,15) suggest that the human brain demonstrates plasticity, there are few studies that provide brain mapping evidence for cortical reorganization after motorcortex lesions. A single case report utilizing magnetoencephalography suggested reorganization in the somatosenso...