Enhancing upper limb motor recovery prediction after acute stroke using EEG and subacute data

Electroencephalography (EEG) has shown promise in assessing and monitoring functional recovery in stroke survivors, but its utility in predicting upper limb motor recovery in a data-driven framework remains underexplored. This study presents a novel EEG-based machine-learning model, StrokeRecovNet, developed to predict motor recovery outcomes based on the upper extremity subscale of the Fugl-Meyer Assessment (FMAUE). StrokeRecovNet is a feed-forward neural network optimized for regression tasks, leveraging 221 candidate EEG biomarkers, spanning spectral and functional connectivity domains, along with baseline clinical information. These inputs are used to predict follow-up FMAUE scores in stroke survivors who underwent standard rehabilitative protocols. We validated our pipeline on two independent datasets of patients in the acute and subacute post-stroke phases. StrokeRecovNet consistently outperformed the proportional recovery rule (PRR), a standard benchmark based on initial impairment, in predicting FMAUE scores in the subacute stage (median absolute error, MAE: StrokeRecovNet = 5.85, PRR = 19.00). Incorporating support data from the subacute dataset led to improved predictive performance in the acute sample (MAE: StrokeRecovNet = 5.87, PRR = 8.80), whereas the model trained solely on the acute data did not (MAE: 13.74). Key features contributing to the model's success included brain symmetry indices and functional connectivity measures, evolving across recovery stages. These findings demonstrate the potential of EEG-based biomarkers to predict individual recovery trajectories. This work introduces a novel, data-driven approach to forecasting upper limb recovery using EEG and suggests that EEG data from the subacute stage, which is more readily available in clinical settings, can enhance early predictions, paving the way for personalized post-stroke rehabilitation strategies.