title: When Does Return of Voluntary Finger Extension Occur Post-Stroke? A Prospective Cohort Study.
abstract: OBJECTIVE
  Patients without voluntary finger extension early post-stroke are suggested to have a poor prognosis for regaining upper limb capacity at 6 months. Despite this poor prognosis, a number of patients do regain upper limb capacity. We aimed to determine the time window for return of voluntary finger extension during motor recovery and identify clinical characteristics of patients who, despite an initially poor prognosis, show upper limb capacity at 6 months post-stroke.
  
  
  METHODS
  Survival analysis was used to assess the time window for return of voluntary finger extension (Fugl-Meyer Assessment hand sub item finger extension≥1). A cut-off of ≥10 points on the Action Research Arm Test was used to define return of some upper limb capacity (i.e. ability to pick up a small object). Probabilities for regaining upper limb capacity at 6 months post-stroke were determined with multivariable logistic regression analysis using patient characteristics.
  
  
  RESULTS
  45 of the 100 patients without voluntary finger extension at 8 ± 4 days post-stroke achieved an Action Research Arm Test score of ≥10 points at 6 months. The median time for regaining voluntary finger extension for these recoverers was 4 weeks (lower and upper percentile respectively 2 and 8 weeks). The median time to return of VFE was not reached for the whole group (N = 100). Patients who had moderate to good lower limb function (Motricity Index leg≥35 points), no visuospatial neglect (single-letter cancellation test asymmetry between the contralesional and ipsilesional sides of <2 omissions) and sufficient somatosensory function (Erasmus MC modified Nottingham Sensory Assessment≥33 points) had a 0.94 probability of regaining upper limb capacity at 6 months post-stroke.
  
  
  CONCLUSIONS
  We recommend weekly monitoring of voluntary finger extension within the first 4 weeks post-stroke and preferably up to 8 weeks. Patients with paresis mainly restricted to the upper limb, no visuospatial neglect and sufficient somatosensory function are likely to show at least some return of upper limb capacity at 6 months post-stroke.
authors: Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute, Amsterdam, The Netherlands.|Neuroscience Campus Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands.
authors: Caroline
authors: C
authors: Winters
authors: Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute, Amsterdam, The Netherlands.|Neuroscience Campus Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands.|Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.|Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, United States of America.
authors: Gert
authors: G
authors: Kwakkel
authors: Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
authors: Rinske
authors: R
authors: Nijland
authors: Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute, Amsterdam, The Netherlands.|Neuroscience Campus Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands.
authors: Erwin
authors: E
authors: van Wegen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005385:Fingers / Q000502:physiology* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D034941:Upper Extremity / Q000502:physiology / Q000503:physiopathology