The PREP algorithm predicts potential for upper limb recovery after stroke. Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials Repetitive arm functional tasks after stroke (RAFTAS): a pilot randomised controlled trial Clinical Relevance of Action Observation in Upper-Limb Stroke Rehabilitation Inter-individual Variability in the Capacity for Motor Recovery After Ischemic Stroke Prediction of Upper Limb Recovery, General Disability, and Rehabilitation Status by Activity Measurements Assessed by Accelerometers or the Fugl-Meyer Score in Acute Stroke The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke. Impact of Time on Improvement of Outcome After Stroke Predicting improvement in the upper paretic limb after stroke: a longitudinal prospective study. Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome? Bilateral Upper Limb Training With Functional Electric Stimulation in Patients With Chronic Stroke EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study. Virtual reality in the rehabilitation of the arm after hemiplegic stroke: a randomized controlled pilot study Long term effects of intensity of upper and lower limb training after stroke: a randomised trial
Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living . Predicting motor recovery after stroke in individual patients is difficult . Accurate prognosis would enable realistic rehabilitation goal - setting and more efficient allocation of re sources . The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke . Forty participants were prospect ively enrolled within 3 days of ischaemic stroke . First ,  shoulder abduction and finger extension strength  were grade d 72 h after stroke onset to compute a shoulder abduction and finger extension score . Secondly , transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb . Third , diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules . Finally , these measures were combined in the PREP algorithm for predicting an individual 's potential for upper limb recovery at 12 weeks , measured with the Action Research Arm Test . A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks , for comparison with predictions from the PREP algorithm . There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm . The algorithm had positive predictive power of 88 % , negative predictive power of 83 % , specificity of 88 % and sensitivity of 73 % . This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients .  PREP may enable tailored planning of rehabilitation and more accurate stratification of patients in clinical trials [ Purpose ] The purpose of this study was to suggest evidence d information about action observation to improve upper limb function after stroke . [ Methods ] A systematic review of r and omized controlled trials involving adults aged 18 years or over and including descriptions of action observation for improving upper limb function  was undertaken . Electronic data bases were search ed , including MEDLINE , CINAHL , and PEDro ( the Physiotherapy Evidence Data base ) , for articles published between 2000 to 2014 . Following completion of the search es , two review ers independently assessed the trials and extracted data using a data extraction form . The same two review ers independently documented the method ological quality of the trials by using the PEDro scale . [ Results ] Five r and omized controlled trials were ultimately included in this review , and four of them ( 80 % ) reported statistically significant effects for motor recovery of upper limb using action observation intervention in between groups . [ Conclusion ] This review of the literature presents evidence attesting to the benefits conferred on stroke patints result ing from participation in an action observation intervention . The body of literature in this field is growing steadily . Further work needs to be done to evaluate the evidence for different conditions after stroke and different duration of intervention Background Repetitive functional task practise ( RFTP ) is a promising treatment to improve upper limb recovery following stroke . We report the findings of a study to determine the feasibility of a multi-centre r and omised controlled trial to evaluate this intervention . Methods A pilot r and omised controlled trial recruited patients with new reduced upper limb function within 14 days of acute stroke from three stroke units . Participants were r and omised to receive a four week upper limb RFTP therapy programme consisting of goal setting , independent activity practise , and twice weekly therapy review s in addition to usual post stroke rehabilitation , or usual post stroke rehabilitation .  The recruitment rate ; adherence to the RFTP therapy programme ; usual post stroke rehabilitation received ; attrition rate ; data quality ; success of outcome assessor blinding ; adverse events ; and the views of study participants and therapists about the intervention were recorded . Results Fifty five eligible patients were identified , 4 - 6 % of patients screened at each site . Twenty four patients participated in the pilot study . Two study sites met the recruitment target of 1–2 participants per month . The median number of face to face therapy sessions received was 6 [ IQR 3–8 ] . The median number of daily repetitions of activities recorded was 80 [ IQR 39–80 ] . Data about usual post stroke rehabilitation were available for 18/24 ( 75 % ) . Outcome data were available for 22/24 ( 92 % ) at one month and 20/24 ( 83 % ) at three months . Outcome assessors were unblinded to participant group allocation for 11/22 ( 50 % ) at one month and 6/20 ( 30 % ) at three months . Four adverse events were considered serious as they result ed in hospitalisation . None were related to study treatment . Feedback from patients and therapists about the RFTP programme was mainly positive . Conclusions A multi-centre r and omised controlled trial to evaluate an upper limb RFTP therapy programme provided early after stroke is feasible and acceptable to patients and therapists , but there are issues which need to be addressed when design ing a Phase III study . A Phase III study will need to monitor and report not only recruitment and attrition but also adherence to the intervention , usual post stroke rehabilitation received , and outcome assessor blinding . Trial registration International St and ard R and omised Controlled Trials Number ( IS RCT N ) Objective . A r and omized controlled observer-blind trial was design ed to evaluate the effectiveness of action observation as an add-on treatment to the st and ard rehabilitation of upper-limb function , early after stroke . Methods . Stroke survivors ( N = 102 ) were consecutively recruited from 13 centers 30 days ( ±7 ) after a first-ever stroke and r and omly assigned to the  experimental ( EG )  or  control group (  CG ) . EG participants watched video footage of daily routine tasks ( actions ) carried out with the upper limb in order to prepare to imitate the presented action . At the end of each sequence , a therapist prompted the patient to perform the same movement for 2 minutes , providing help when needed . Static images without animals or human beings were shown to the CG . At the end of each sequence , the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG . Results for the Fugl-Meyer test , Frenchay Arm test , Box and Block test ( BBT ) , Modified Ashworth Scale , and Functional Independence Measure Motor items were recorded before treatment ( T0 ) , after 4 weeks of treatment ( T1 ) , and at the follow-up visit 4 to 5 months after the conclusion of treatment ( T2 ) . Results . An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs . A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT , showing significant T0–T1 and T0–T2 differences in favor of EG . Conclusion . This multicenter trial endorses the use of action observation in upper-extremity rehabilitation , along with a role for the mirror neuron system in poststroke recovery Background . Motor recovery after stroke is predicted only moderately by clinical variables , implying that there is still a substantial amount of unexplained , biologically meaningful variability in recovery . Regression diagnostics can indicate whether this is associated simply with Gaussian error or instead with multiple sub population s that vary in their relationships to the clinical variables . Objective . To perform regression diagnostics on a linear model for recovery versus clinical predictors . Methods . Forty-one patients with ischemic stroke were studied . Impairment was assessed using the upper extremity Fugl-Meyer Motor Score . Motor recovery was defined as the change in the upper extremity Fugl-Meyer Motor Score from 24 to 72 hours after stroke to 3 or 6 months later . The clinical predictors in the model were age , gender , infa rct location ( subcortical vs cortical ) , diffusion weighted imaging infa rct volume , time to re assessment , and acute upper extremity Fugl-Meyer Motor Score . Regression diagnostics included a Kolmogorov-Smirnov test for Gaussian errors and a test for outliers using Studentized deleted residuals . Results . In the r and om sample , clinical variables explained only 47 % of the variance in recovery . Among the patients with the most severe initial impairment , there was a set of regression outliers who recovered very poorly . With the outliers removed , explained variance in recovery increased to 89 % , and recovery was well approximated by a proportional relationship with initial impairment ( recovery ≅ 0.70 × initial impairment ) . Conclusions . Clinical variables only moderately predict motor recovery . Regression diagnostics demonstrated the existence of a sub population of outliers with severe initial impairment who show little recovery . When these outliers were removed , clinical variables were good predictors of recovery among the remaining patients , showing a tight proportional relationship to initial impairment Objective This study investigated the clinical predictive value of the Fugl-Meyer Assessment ( FMA ) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke . Design The prospect i ve cohort ( n = 129 ) was recruited from a general hospital ; activity variables and FMA score at intake were related to the FMA , the modified Rankin Scale , and rehabilitation status after 3 mos of follow-up . The prediction model was based on binary logistic regression . Results Although the FMA score at intake has the best overall predictive value for all three outcome measures ( FMA3 , 87.6 % ; modified Rankin Scale , 85.3 % ; RS , 73.6 % ) , the activity of the impaired arm as assessed by the accelerometer has the best predictive value to determine patients who are at risk for continued disability ( modified Rankin Scale score 1 , 95.1 % ) . The most difficult outcome measure for prediction is the rehabilitation status ; specifically , the patients who went home are predicted imprecisely . The ratio variable is the least accurate predictor of all tested variables . Conclusions The  FMA arm score at intake is the best predictor for arm recovery and general disability . The activity of the impaired arm is an excellent predictor for prolonged disability and is an alternative to the FMA score when it is impossible to score the FMA in the acute phase of stroke Background Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation . Initial severity of motor impairment , however , is not modifiable by rehabilitation , and increased one-on-one treatment is not always feasible . Alternative methods to increase intensity and improve upper-limb function are needed . Objective The purpose of this study was to examine  caregiver involvement in upper-limb treatment as a method to improve upper-limb function . Design This study was a secondary analysis of a multi-site r and omized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation . Methods Data from 50 individuals with subacute stroke who were r and omly assigned to the experimental group ( upper-limb exercise )  were used for the analysis . Outcome variables were measured at baseline and at completion of the 4-week intervention . Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance . Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment ( intensity ) as covariates , a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function , as measured by change scores on the Chedoke Arm and H and Activity Inventory and the Motor Activity Log . Results Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise . The multiple regression analysis showed that Fugl-Meyer score , treatment intensity , and caregiver support were significant predictors of upper-limb improvement ( R2=.240–.292 ) . In the regression models , caregiver support accounted for 5 % to 9 % of upper-limb improvement . Limitations Support was coded as a dichotomous variable , and thus the degree of support or qualitative nature of support was not captured . Conclusions Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity . Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results Background and Objective . Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension ( FE ) early after stroke . The present study aim ed to determine the effects of modified constraint-induced movement therapy ( mCIMT ) and electromyography-triggered neuromuscular stimulation ( EMG-NMS ) on upper limb capacity early poststroke . Methods . A total of 159 ischemic stroke patients were included : 58 patients with a favorable prognosis ( > 10 ° of FE ) were r and omly allocated to 3 weeks of  mCIMT or usual care only  ; 101 patients with an unfavorable prognosis were allocated to 3-week  EMG-NMS or usual care only . Both interventions started within 14 days poststroke , lasted up until 5 weeks , focused at preservation or return of FE . Results . Upper limb capacity was measured with the Action Research Arm Test ( ARAT ) , assessed weekly within the first 5 weeks poststroke and at post assessment s at 8 , 12 , and 26 weeks . Clinical ly relevant differences in ARAT in favor of mCIMT were found after 5 , 8 , and 12 weeks poststroke ( respectively , 6 , 7 , and 7 points ; P < .05 ) , but not after 26 weeks . We did not find statistically significant differences between mCIMT and usual care on impairment measures , such as the Fugl-Meyer assessment of the arm ( FMA-UE ) . EMG-NMS did not result in significant differences . Conclusions . Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis ; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial . Despite meaningful improvements in upper limb capacity , no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS AIM The aim of this study was to investigate the role of mental practice ( MP ) in functional recovery of upper limbs in stroke patients . METHODS Thirty-six hemiparetic stroke patients ( 15 females and 21 males ) were enrolled in a r and omized single blind cross-over study . Patients were r and omly divided into two groups , ( A and B ) each comprising 18 patients . Patients in group A underwent the conventional neuro-rehabilitation protocol ( therapeutic exercise and occupational therapy ) for three weeks ( 3 hours a day , 5 days a week ) and in the following 3 weeks , they received an additional 60 minutes of MP training . Patients in group B , instead , underwent , in the first 3 weeks , the rehabilitation program plus MP training and in the following 3 weeks , only the conventional neurorehabilitation program . All patients were evaluated at baseline ( T0 ) , at 3 weeks ( T1 ) and at 6 weeks ( T2 ) with the Motricity Index ( MI ) and the Arm Functional Test ( AFT ) . RESULTS At baseline ( T0 ) there were no significant differences at MI and AFT between the two groups . At T1 the differences between the two groups became significant . At T2 the difference was once again minimal . CONCLUSION These results suggest that MP could be used to complement to the conventional neurorehabilitative treatments usually prescribed for post-stroke neuromotor recovery . However , there is still much to be tested and discussed regarding the role that MP might play in the treatment of neurological patients OBJECTIVE To determine the prognostic value of clinical assessment and motor evoked potentials for upper limb strength and functional recovery after acute stroke , and to establish the possible use of motor evoked potentials in rehabilitation . DESIGN A prospect i ve study . SUBJECTS Fifty-two patients with hemiparesis were enrolled one month post-stroke ; 38 patients concluded the study at 12 months . METHODS Motor evoked potentials were recorded at baseline and after one month .  Upper limb muscular strength ( Medical Research Council Scale , MRC ) and functional tests ( Frenchay Arm Test , Barthel Index ) were used as dependent outcome variables 12 months later . Motor evoked potentials were classified as present or absent . Predictive values of motor evoked potentials and MRC were evaluated . RESULTS At 12 months , patients with baseline recordable motor evoked potentials showed a good functional recovery ( positive predictive value 94 % ) . The absence of motor evoked potentials did not exclude muscular strength recovery ( negative predictive value 95 % ) . Motor evoked potentials had a higher positive predictive value than MRC only in patients with MRC < 2 . CONCLUSION Motor evoked potentials could be a supportive tool to increase the prognostic accuracy of upper limb motor and functional outcome in hemiparetic patients , especially those with severe initial paresis ( MRC < 2 ) and /or with motor evoked potentials absent in the post-stroke acute phase Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset PURPOSE A number of longitudinal studies show that about one third of all patients regain dexterity following a stroke . However , the determinants of improvement of upper limb function are largely unknown . The aim of the present study was to investigate the longitudinal relationship of functional change in the upper paretic limb and change in time-dependent covariates in order to develop a multivariable regression model to predict improvement in dexterity . METHODS Based on 18 repeated measurements over time during the first post-stroke year , 101 stroke patients with first-ever ischemic middle cerebral artery strokes were investigated . Baseline characteristics as well as longitudinal information from  Action Research Arm Test ( ARAT ) , Fugl-Meyer arm and h and score ( FM-arm and FM-h and )  ,  Motricity Index arm and leg score ( MI-arm and MI-leg ) , letter cancellation task ( LCT ) , Fugl-Meyer balance score ( FM-balance ) and progress of time  were obtained prospect ively . Outcome constituted of change scores on the ARAT over first year post stroke . Adjoining measurements of time-dependent variables were used to calculate time-dependent changes producing change scores . RESULTS In total 1570 of the 1717 change scores were available for longitudinal regression analysis . The regression model shows that FM-h and change scores was the most important relative factor in predicting improvement on ARAT ( st and ardized beta=0.357 ; p<0.001 ) followed by change scores on FM-arm ( beta=0.007 ; p<0.001 ) , whereas progress of time was significantly negatively associated with improvement on ARAT ( beta=-0.001 ; p<0.001 ) . CONCLUSIONS Functional improvement of the upper paretic limb is mainly determined by improvement of the paretic h and , followed by synergistic independent movement of the paretic arm . Progress of time itself is an independent covariate that is negatively associated with upper limb function suggesting that most pronounced improvements occur earlier after stroke Objective : To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome . Design : A r and omized controlled trial . Setting : A stroke unit which provides acute care and rehabilitation for all stroke admissions . Subjects : One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days . Intervention : The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist , commencing within 10 days of stroke , and available up to 30 minutes/day , five days/week for six weeks . The control group received stroke unit care . Main outcome measures : The primary outcome measure was the Action Research Arm Test ( ARAT ) three months after stroke . Secondary outcome measures : Motricity Index ; Frenchay Arm Test ; upper limb pain ; Barthel ADL Index ; Nottingham E-ADL Scale ; and costs to health and social services at three and six months after stroke . Results : There were no differences in outcomes between the intervention and control groups three and six months after stroke . During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as in patients . The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001 ) . There were no differences in service costs . Conclusions : An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke . The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias Background . The recovery rate of upper limb function after stroke is poor when compared with independent walking . Therefore , effective methods are warranted for upper limb rehabilitation . Objective . The aim of this study was to investigate the effectiveness of functional electric stimulation ( FES ) with bilateral activities training on upper limb function . Methods . This study was a double-blinded r and omized controlled trial . Twenty patients were recruited 6 months after the onset of stroke and completed 15 training sessions . Participants were r and omly assigned to the FES group or to the control group . Each session consisted of stretching activities ( 10 minutes ) , FES with bilateral tasks ( 20 minutes ) , and occupational therapy treatment ( 60 minutes ) . The participants used a self-trigger mechanism , with an accelerometer as a motion detector , for generating an electric stimulation pattern that was synchronized with the bilateral upper limb activities during the training . The participants in the control group received the same duration of stretching and occupational therapy training except that they just received placebo stimulation with the bilateral tasks . The outcome measures included Functional Test for the Hemiplegic Upper Extremity ( FTHUE ) , Fugl — Meyer Assessment ( FMA ) , grip power , forward reaching distance , active range of motion of wrist extension , Functional Independence Measure , and Modified Ashworth Scale . Results . At baseline comparison , there was no significant difference in both groups . After 15 training sessions , the FES group had significant improvement in FMA ( P = .039 ) , FTHUE ( P = .001 ) , and active range of motion of wrist extension ( P = .020 ) when compared with the control group . Conclusions . Bilateral upper limb training with FES could be an effective method for upper limb rehabilitation of stroke patients after 15 training sessions Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients Objective : To assess the feasibility of a trial to investigate the effectiveness of virtual reality-mediated therapy compared to conventional physiotherapy in the motor rehabilitation of the arm following stroke , and to provide data for a power analysis to determine numbers for a future main trial . Design : Pilot r and omized controlled trial . Setting : Clinical research facility . Participants : Eighteen people with a first stroke , 10 males and 8 females , 7 right and 2 left side most affected . Mean time since stroke 10.8 months . Interventions : Participants were r and omized to a virtual reality group or a conventional arm therapy group for nine sessions over three weeks . Main measures : The upper limb Motricity Index and the Action Research Arm Test were completed at baseline , post intervention and six weeks follow-up . Results : Outcome data were obtained from 95 % of participants at the end of treatment and at follow-up : one participant withdrew . Compliance was high ; only two people reported side-effects from virtual reality exposure . Both groups demonstrated small ( 7–8 points on upper limb Motricity Index and 4 points on the Action Research Arm Test ) , but non-significant , changes to their arm impairment and activity levels . Conclusion : A r and omized controlled trial of virtual reality-mediated therapy comparable to conventional therapy would be feasible , with some suggested improvements in recruitment and outcome measures . Seventy-eight participants ( 39 per group ) would be required for a main trial Objective : To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases . Design : A three group r and omised controlled trial with repeated measures was used . Method : One hundred and one patients with a primary middle cerebral artery stroke were r and omly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on ( 1 ) upper limb function , ( 2 ) lower limb function or ( 3 ) immobilisation with an inflatable pressure splint ( control group ) . Follow up assessment s within and between groups were compared at 6 , 9 , and 12 months after stroke . Results : No statistically significant effects were found for treatment assignment from 6 months onwards . At a group level , the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained . However , no significant differences in functional recovery between groups were found for Barthel index ( BI ) , functional ambulation categories (FAC),action research arm test ( ARAT ) , comfortable and maximal walking speed , Nottingham health profile part 1(NHP-part 1 ) , sickness impact profile-68 ( SIP-68 ) , and Frenchay activities index ( FAI ) from 6 months onwards . At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function ( n=8 and 5 , respectively ) and lower limb function ( n=19 and 9 , respectively ) . Activities of daily living ( ADL ) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards . In particular , patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards . Conclusions : On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme . However , a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity , walking ability , and ADL beyond the error threshold
The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function
Objective : To systematic ally review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke .
To identify which , if any variables predict upper limb recovery following stroke .