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Motor recovery usually occurs in well-described patterns after stroke. Within 48 hours of loss of movement, reflexes become more active in the involved arm and leg. As muscle tone returns, the arm and leg position themselves in resting postures known as synergy patterns.

• Arm flexor synergy: Shoulder flexion, adduction, internal rotation; elbow flexion; wrist flexion; finger flexion
• Arm extensor synergy: Shoulder, elbow, wrist, finger extension
• Leg flexor synergy: Hip flexion, adduction; knee flexion; ankle dorsiflexion
• Leg extensor synergy: Hip, knee extension; ankle plantar flexion

Voluntary movement may eventually return, and spasticity decreases with increased voluntary movement. However, muscle stretch reflexes always remain increased despite total recovery. Predictors for poor return of movement include absence of motion after 4 weeks.

Researchers are beginning to confirm the theories of motor recovery despite brain damage after stroke, which were first presented in the early 1980's. Plastic responses may occur in areas of the brain outside the damaged areas that result in partial return of lost function. Although findings such as these continue to support the need for rehabilitation services months or even years after a stroke occurs, these studies have small numbers of subjects. Large randomized clinical trials need to be completed in the future to convince the medical community that intensive rehabilitation interventions contribute to the improvement and maintenance of poststroke functional skills.