Motor recovery: upper extremity, lower extremity, trunk

1. Case. A 55-year-old man, 6 weeks post-left-MCA stroke. Right UE: FMA-UE 22/66, can lift the arm against gravity through partial range, no functional grasp. Right LE: FMA-LE 18/34, ambulates 10 m with a single-point cane and contact-guard assist. Trunk Impairment Scale 11/23.

2. CPG section. AHA/ASA 2016 recommends task-specific training for both UE and LE motor recovery (Class I, Level A). The Fugl-Meyer Assessment (Fugl-Meyer AR et al. *Scand J Rehabil Med*. 1975;7:13–31) remains the most widely used impairment measure post-stroke. The Trunk Impairment Scale (Verheyden G, Mertin J, Preger R, Kiekens C, De Weerdt W. *Clin Rehabil*. 2004;18:326–334) quantifies static sitting balance (max 7), dynamic sitting balance (max 10), and coordination (max 6); total 0–23; interrater ICC 0.99, Cronbach α 0.89.

3. Reasoning walkthrough. Stratify by severity. FMA-UE 22 places him in moderate-severe impairment per Woytowicz EJ et al. (*Arch Phys Med Rehabil*. 2017;98:456–462): severe ≤19, moderate-severe 20–28, moderate-mild 29–47, mild ≥48. He does not yet meet EXCITE entry criteria (≥10° wrist and 10° finger extension). Plan: high-repetition task practice with shaping, bilateral training, and progressive challenge. For LE and trunk, build core/trunk stability work into stepping tasks. Track FMA-UE and FMA-LE every 2–4 weeks. MCID for FMA-UE in minimal-to-moderate chronic stroke = 4.25 (grasp), 5.25 (release), 7.25 (arm movement) (Page SJ, Fulk GD, Boyne P. *Phys Ther*. 2012;92:791–798). For severe/subacute patients, MCID is approximately 9–10 points (Hiragami S et al., *J Phys Ther Sci*. 2019;31:917–921). MCID for FMA-LE in chronic stroke = 6 points (Pandian S, Arya KN, Kumar D. *Top Stroke Rehabil*. 2016).

4. Outcome measure. FMA-UE max 66 (shoulder/elbow/forearm 36; wrist 10; hand 14; coordination 6). FMA-LE max 34. TIS max 23.