Can your arm and hand still improve years after a stroke?

Why the arm matters so much

Difficulty using the arm and hand is one of the most common long-term effects of stroke, and one of the most disabling. It affects dressing, cooking, work, hobbies and caring for others, and it often affects confidence too.

Many people are told, directly or indirectly, that most recovery happens in the first three to six months, and that after that progress slows to a stop. That can leave people feeling there’s no point continuing.

What the Queen Square research found

The Queen Square Upper Limb Neurorehabilitation programme is an NHS service at the National Hospital for Neurology and Neurosurgery in London. It offers a high-intensity programme of 90 hours of therapy over three weeks, built around each person’s own functional goals.

In 2019 the team published outcomes for 224 people who completed the programme. The median time since their stroke was 18 months, so many were well past the period when recovery is usually expected to plateau. They were assessed using standard measures of arm impairment and everyday arm use on admission, at discharge, and six weeks and six months later.

The researchers found that people made clinically important improvements in both impairment and activity, and that improvements continued after the programme finished. People with a range of impairments and fatigue levels were able to complete it.¹

What this means if you’re living with a weaker arm

Not everyone can access an intensive programme like this, and results will vary from person to person. But the research supports some important principles:

• It’s rarely too late. Change is possible well beyond the early months.
• Dose matters. Recovery is linked to how much meaningful practice the arm gets, not just occasional therapy sessions.
• Goals matter. Practice built around things you want to do, like holding a cup, typing or doing up buttons, is more motivating and more relevant.

NICE’s 2023 stroke rehabilitation guideline reflects the same direction, recommending more intensive rehabilitation than before and offering further rehabilitation to people with continuing impairments.²

How occupational therapy helps

An OT looks at how your arm works in real life, not just in isolation. That usually means:

• assessing movement, sensation, strength, tone and pain, and how they affect daily tasks
• setting goals with you that matter, for example cooking, work or personal care
• turning daily routines into practice opportunities, so the arm is used many more times a day
• grading tasks so they’re challenging but achievable, and progressing them over time
• managing fatigue, so practice is sustainable
• advising on splints, positioning or equipment where appropriate

Questions

References

1. Ward NS, Brander F, Kelly K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry 2019. Link
2. National Institute for Health and Care Excellence. Stroke rehabilitation in adults (NG236), 2023. Link

This article is general information, not a substitute for individual clinical advice. If you have new or worsening symptoms, speak to your GP or NHS 111.