title: Functional recovery of the paretic upper limb after stroke: who regains hand capacity?
abstract: OBJECTIVE
  To describe recovery of upper limb capacity after stroke during inpatient rehabilitation based on the Stroke Upper Limb Capacity Scale (SULCS).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Inpatient department of a rehabilitation center.
  
  
  METHODS
  Patients with stroke (N=299) admitted to a specialized stroke rehabilitation center.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Upper limb capacity was assessed at the start and end of the rehabilitation phase with the SULCS (range, 0-10). The following demographic and clinical characteristics were registered: age, sex, side of stroke, stroke type, time since stroke, and length of stay in the rehabilitation center.
  
  
  RESULTS
  On admission, 125 patients had no hand capacity (SULCS score, 0-3), 58 had basic hand capacity (SULCS score, 4-7), and 116 had advanced hand capacity (SULCS score, 8-10). Of the patients without initial hand capacity, 41% regained some hand capacity (SULCS score, ≥4) at discharge. Of these, patients with SULCS scores of 2 and 3 had 29 and 97 times greater chance of regaining some hand capacity compared with patients with an initial SULCS score of 0, respectively. Of the patients with initial basic hand capacity, 78% regained advanced hand capacity at discharge. The SULCS score on admission explained 51% of the SULCS score variance at discharge, while time since stroke was negatively associated with upper limb recovery, explaining an additional 7% of the SULCS score variance at discharge.
  
  
  CONCLUSIONS
  Even patients with minimal proximal shoulder and elbow control of the upper paretic limb on admission in a rehabilitation center have a fair chance of regaining some hand capacity in the long-term after stroke, whereas patients without such proximal arm control have a much poorer prognosis for regaining hand capacity.
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands. a.houwink@reval.umcn.nl
authors.forename: Annemieke
authors.initials: A
authors.lastname: Houwink
authors.forename: Rinske H
authors.initials: RH
authors.lastname: Nijland
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Geurts
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome