Early Finger Movement Predicts Upper Limb Recovery After Stroke in Hospital Study

Acute severity of hand-finger paresis evaluated within days of stroke onset is significantly associated with subsequent upper-limb motor recovery and functional independence across the subacute rehabilitation phase, according to a retrospective observational cohort study conducted at Fujita Health University Hospital in Japan. Researchers evaluated clinical records from 356 individuals recovering from unilateral stroke and observed that initial scores on the Stroke Impairment Assessment Set Finger-Function test, administered at an average of 1.7 days post-stroke, demonstrated strong multivariable associations with distal finger recovery, proximal arm capacity, object manipulation proficiency, and basic selfcare abilities measured nearly three months later at hospital discharge.

Hemiparesis affecting the upper extremity represents one of the most common and persistent secondary complications following a cerebrovascular event, occurring in up to three-quarters of individuals who experience a stroke. While biological recovery processes and post-stroke plasticity often yield gradual motor improvements over the first six months following injury, long-term functional motor deficits frequently persist for years, diminishing quality of life. Clinical prognostic models consistently indicate that baseline motor severity serves as the primary predictor of upper-limb outcomes, yet administering comprehensive multi-joint motor batteries during the initial, medically unstable acute phase remains challenging when patients are unable to sit upright or tolerate prolonged testing procedures.

To address this clinical assessment barrier, the investigators examined whether a single, rapid bedside evaluation of finger movement could provide robust prognostic information across distinct functional domains. The study analyzed consecutively admitted patients between September 5, 2019, and July 12, 2021, who received continuous rehabilitation extending seamlessly from acute hospitalization through subacute inpatient wards. Eligible participants met strict criteria, including a diagnosis of supratentorial ischemic stroke or intracerebral hemorrhage, a Glasgow Coma Scale score of at least 9 points at initial evaluation, and no preexisting motor deficits in the paretic arm, while individuals with bilateral hemispheric lesions, traumatic brain injuries, brain tumors, or recurrent strokes requiring departmental transfer were excluded.

The primary baseline assessment evaluated the quality and fractionation of finger movements using the Stroke Impairment Assessment Set Finger-Function scale, an eight-level clinical metric ranging from score 0, denoting complete absence of voluntary movement, through score 5, representing performance as smooth as the unaffected side. Intermediate classifications systematically differentiate mass flexion or extension synergies from partial individual digit movements and varying degrees of motor clumsiness. Because the test isolates distal movements that are minimally affected by gravity, clinicians can complete the evaluation in approximately one minute while the patient remains resting in a supine position, avoiding the physical demands and postural prerequisites associated with multi-segment arm assessments or strength-based scores such as shoulder abduction and finger extension.

The study cohort comprised 356 participants with a mean age of 66.7 years and an average hospital stay of 85.4 days, during which patients received intensive daily therapy comprising 60 minutes of physical therapy, 60 minutes of occupational therapy, and speech therapy when indicated, delivered seven days per week. Baseline severity distributions showed that 110 participants presented with complete absence of finger movement, representing 30.9 percent of the cohort, while 22 patients presented with score 1A, 22 with score 1B, 34 with score 1C, 21 with score 2, 25 with score 3, 76 with score 4, and 46 with score 5. Patients presenting with more severe initial motor deficits generally required longer hospital stays before achieving discharge readiness.

Discharge outcomes assessed at an average follow-up of 86.9 days encompassed four distinct outcome measures spanning impairment, motor capacity, and practical activities of daily living. Distal motor recovery was recorded using repeat Stroke Impairment Assessment Set Finger-Function testing, while proximal shoulder and elbow coordination was assessed using the Knee-Mouth test, requiring patients to lift the paretic hand from the opposite knee to the mouth while seated. Functional motor capacity was measured with the Simple Test for Evaluating Hand Function, a timed Japanese clinical battery evaluating object grasping, pinching, and lateral transfer across ten distinct object types scored from 0 to 100. Functional independence in daily living was quantified through the six-item selfcare subscale of the Functional Independence Measure, covering eating, grooming, bathing, dressing, and toileting on a scale from 6 to 42.

Multivariable regression models adjusting for patient age and total length of hospital stay revealed statistically significant associations between acute finger function and all four discharge measures. In ordinal logistic regression models evaluating distal recovery, acute scores of 1A, 1B, and 1C yielded adjusted odds ratios of 9.14, 12.42, and 14.89, respectively, compared to baseline score 0, with odds ratios escalating to 66.11 for score 2, 75.61 for score 3, and 233.69 for score 4. For proximal shoulder and elbow recovery on the Knee-Mouth test, adjusted odds ratios relative to baseline score 0 reached 4.07 for score 1A, 8.11 for score 1B, 14.20 for score 1C, 26.06 for score 2, 18.62 for score 3, and 76.18 for score 4, demonstrating that acute distal voluntary control closely tracked proximal motor improvement.

Generalized linear regression models evaluating manual motor capacity on the Simple Test for Evaluating Hand Function demonstrated substantial score increments associated with early finger function. Compared with the baseline reference group of score 0, unstandardized regression coefficients indicated discharge score advantages of 17.54 points for score 1A, 16.73 points for score 1B, 30.09 points for score 1C, 29.65 points for score 2, 36.72 points for score 3, 42.62 points for score 4, and 47.79 points for score 5. The emergence of minimal voluntary control represented by score 1A produced a marked jump in functional capacity compared to score 0, suggesting a functional threshold where rudimentary digit movement permits patients to engage in object manipulation practice during rehabilitative therapy.

Analysis of activities of daily living through the Functional Independence Measure selfcare score demonstrated positive multivariable associations across all baseline score categories, with regression coefficients reflecting mean increases between 5.44 and 8.13 points over baseline score 0. However, unlike the pronounced stepwise divisions seen in motor capacity, discharge selfcare performance exhibited smaller relative differences between impairment groups, accompanied by substantial variability among individuals who entered rehabilitation with score 0. Several individuals with initial complete hand paralysis achieved relatively high levels of selfcare independence, reflecting the adoption of compensatory movement strategies and increased reliance on the unaffected limb to complete routine daily selfcare tasks.

The physiological mechanisms linking early finger motility to comprehensive upper-limb recovery center on the anatomical preservation of the corticospinal tract, where monosynaptic projections from the primary motor cortex to spinal motor pools mediate individual digit fractionation. The authors noted that the presence of voluntary finger movement within 72 hours of stroke onset indicates surviving corticospinal pathways capable of neuroplastic reorganization, enabling patients to engage in repetitive task-oriented training that stimulates motor relearning. Limitations of the research include its single-center retrospective design, lack of standardization regarding rehabilitation interventions, exclusion of patients with severe cognitive impairment or bilateral strokes, and reliance on an assessment tool that may lack sensitivity to high-level motor clumsiness, highlighting the need for prospective multicenter studies to confirm whether early finger evaluations can optimize structured prognostic algorithms.

Subject of Research: Acute finger paresis severity and post-stroke upper limb recovery

Article Title: Impact of early severity of finger paresis on upper limb motor recovery and functional outcomes in people after stroke: a retrospective cohort study

Article References: Uehara, S., Nagasaka, K., Matsuura, D., Maeda, H., & Otaka, Y. (2026). Impact of early severity of finger paresis on upper limb motor recovery and functional outcomes in people after stroke: a retrospective cohort study. Frontiers in Rehabilitation Sciences, 7, Article 1923642. https://doi.org/10.3389/fresc.2026.1923642

Image Credits: AI Generated

DOI: 10.3389/fresc.2026.1923642

Keywords: stroke rehabilitation, motor recovery, finger paresis, upper extremity, clinical prediction, cohort study, activities of daily living, neurology, Impact, early, severity, finger