The factors determining recovery from hemiparetic stroke are manifold. We studied spontaneous arm movement activity in the acute phase after stroke as a predictor of recovery. Included in this prospective study were 25 patients (63 ± 10 years; 9 women, 16 men) with acute middle cerebral artery stroke and 7 control patients without neurological disease (61 ± 14 years; 3 women, 4 men). Movement activity was measured continuously for 4 days in both arms using Actiwatches and analysed off-line. Movement activity of the nonaffected arm ranged from <10 to >16 h per day in the stroke patients. Nine stroke patients with an initial decline in arm movement activity showed no increase in movement activity in either arm over 4 days after stroke, and the other 16 patients improved steadily after admission (p < 0.003). C-reactive protein was elevated in the non-recovering patients (4.4 ± 4.9 mg/dl) related to a low number of waking hours (r = -0.512, p < 0.01). Stroke severity, location and treatment, as well as arterial blood pressure (162 ± 21 mmHg) and body temperature (36.9 ± 06 °C) were not different among the groups. The impairment was still different among the two groups 3 months after stroke. Our results support the notion that in the acute stage after middle cerebral artery stroke there are patients with a secondary decline in general motor activity related to an enhanced sleep demand as assessed with accelerometry. This impairment was related to elevated C-reactive protein.

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