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Background. Early prediction of outcome after stroke is becoming increasingly important, as most patients are discharged from hospital stroke units within several days after stroke. Objectives. The primary purposes of this study were: (1) to determine the accuracy of physical therapists' predictions at hospital stroke units regarding upper-limb (UL) function, (2) to develop a computational prediction model (CPM), and (3) to compare the accuracy of physical therapists' and the CPM's predictions. Secondary objectives were to explore the impact of timing on the accuracy of the physical therapists' and CPM's predictions and to investigate the direction of the difference between predicted and observed outcomes. Finally, this study investigated whether the accuracy of physical therapists' predictions was affected by their experience in stroke rehabilitation. Design. A prospective cohort study was conducted. Methods. Physical therapists made predictions at 2 time points-within 72 hours after stroke onset (T72h) and at discharge from the hospital stroke unit (Tdischarge)- about UL function after 6 months in 3 categories, derived from the Action Research Arm Test. At the same time, clinical variables were measured to derive a CPM. The accuracy of the physical therapists' and CPM's predictions was evaluated by calculating Spearman rank correlation coefficients (rs) between predicted and observed outcomes. Results. One hundred thirty-one patients and 20 physical therapists participated in the study. For the T72hassessment, the rs value between predicted and observed outcomes was .63 for the physical therapists' predictions and .75 for the CPM's predictions. For the Tdischarge assessment, the rs value for the physical therapists' predictions improved to .75, and the rs value for the CPM's predictions improved slightly to .76. Limitations. Physical therapists administered a test battery every 3 days, which may have enhanced the accuracy of prediction. Conclusions. The accuracy of the physical therapists' predictions at T72h was lower than that of the CPM's predictions. At Tdischarge, the physical therapists' and CPM's predictions are about equally accurate. [ABSTRACT FROM AUTHOR]

Background and Purpose. It is largely unknown how adaptive motor control of the paretic upper limb contributes to functional recovery after stroke. This paucity of knowledge emphasizes the need for longitudinal 3-dimensional (3D) kinematic studies with frequent measurements to establish changes in coordination after stroke. A portable 3D kinematic setup would facilitate the frequent follow-up of people poststroke. This case report shows how longitudinal kinematic changes of the upper limb can be measured at a patient's home using a portable 3D kinematic system in the first 6 months poststroke. Case Description. The outcomes of the upper-limb section of the Fugl-Meyer Motor Assessment (FMA), the Action Research Arm Test (ARAT), and 3D kinematic analyses were obtained from a 41-year-old man with a left hemispheric stroke. Three-dimensional kinematic data of the paretic upper limb were collected during a reach-to-grasp task using a portable motion tracker in 5 measurements during the first 6 months after stroke. Data from an individual who was healthy were used for comparison. Outcomes. The FMA and ARAT scores showed nonlinear recovery profiles, accompanied by significant changes in kinematic outcomes over time poststroke. Specifically, elbow extension increased, forward trunk motion decreased, peak hand speed increased, peak hand opening increased, and peak hand opening occurred sooner after peak hand speed. Discussion. This case report illustrates the feasibility of frequently repeated, on-site 3D kinematic measurements of the paretic upper limb. Early after stroke, task performance was mainly driven by adaptive motor control, whereas adaptations were mostly reduced at 26 weeks poststroke. The presented approach allows the investigation of what is changing in coordination and how these changes are related to the nonlinear pattern of improvements in body functions and activities after stroke. [ABSTRACT FROM AUTHOR]

Background: Stroke rehabilitation aims to reduce impairments and promote activity and participation among patients. A major challenge for stroke rehabilitation research is to develop interventions that can reduce patients' neurological impairments. Until now, there has been no breakthrough in this research field. To move stroke rehabilitation forward, we need more knowledge about underlying mechanisms that drive spontaneous (i.e., reactive) neurobiological recovery after stroke and factors that can be used to optimize its prediction early after stroke onset., Objective: The aim of the present invited review was therefore to elaborate on the time window of reactive neurobiological recovery, the proportional recovery rule and its generalizability to other neurological impairments, as well as to discuss the consequences for designing stroke recovery and rehabilitation trials., Methods: In this narrative review, we offer suggestions to optimize the research designs of future stroke rehabilitation and recovery trials post stroke, in order to overcome the current prognostic heterogeneity introduced by variations in the potential for reactive neurobiological recovery., Findings and Conclusions: There is an urgent need for high-quality, explanatory trials in the first three months post stroke. These trials should preferably stratify patients based on their initial potential for reactive neurobiological recovery, measure recovery repeatedly at fixed times post stroke, and differentiate in their outcomes between behavioural restitution and compensation of functions.