Recovery of daily life upper limb use during stroke rehabilitation: neuroanatomical correlates and associated variables

Background Early after stroke, the upper limb is impaired in ~50% of patients who had a stroke, posing a significant and restrictive challenge to their daily lives. It is unknown how many subacute stroke patients regain good upper limb use in everyday life (ie, performance) during inpatient neurorehabilitation and which clinical and stroke-related neuroanatomical factors are associated with recovery. This study explores these questions using real-world clinical data. Methods Analysis of data prospectively collected on a weekly basis in the clinical routine of patients who had a subacute stroke admitted to a Swiss inpatient neurorehabilitation centre (January 2016–October 2023). Multivariable logistic regression was applied to determine predictors for return of good upper limb performance. Voxel-based lesion symptom mapping (VLSM) was used to determine neuroanatomical correlates for successful return. Results 794 out of 1169 patients who had a stroke (67.9%) did not have a good upper limb performance at a median of 8 days poststroke. Of these, 394 (49.6%) regained good upper limb performance during the subsequent 36 (quartile 1=27, quartile 3=52.75) days. Multivariable logistic regression showed that a younger age, fewer neglect symptoms and better dexterity, stereognosis and general cognition were associated with regaining good upper limb performance. VLSM revealed that less stroke-related injury in the corticospinal tract, right hemispheric attention networks, superior longitudinal fasciculus II and III, insula and putamen was associated with return of good outcome. Conclusions These findings underline that in addition to sensorimotor functioning and intact motor tracts, cognitive functioning and spared attentional networks are essential for recovery of everyday use of the affected upper limb after stroke.