From strength to dexterity. Clinically meaningful recovery of upper limb in individuals with cervical spinal cord injury

Background: Understanding the temporal relationship between neurological and functional recovery after cervical spinal cord injury (SCI) is crucial for optimizing rehabilitation timing and clinical interpretation. This prospective longitudinal study aimed to investigate the temporal dynamics of clinically meaningful neurological and functional recovery in individuals with subacute SCI during inpatient rehabilitation. Methods: We enrolled 21 individuals with incomplete cSCI (AIS C and D). Evaluations were performed every 15 days, from admission up to 120 days. Recovery was defined using the Time to First Improvement based on thresholds exceeding the Minimal Detectable Change or Minimal Important Difference) for neurological scales (Upper Extremities Motor Score—UEMS, Graded Redefined Assessment of Strength, Sensation and Prehension—GRASSP subtests for Strength and Sensation) and the Minimal Clinically Important Difference for functional scales (Spinal Cord Independence Measure, GRASSP Ability and Prehension Performance). Survival analysis (Kaplan–Meier) and pairwise comparisons were used to analyze the temporal sequence of recovery. Results: Neurological and functional recovery showed a parallel macro-evolution. However, granular analysis revealed that motor strength improved significantly earlier than sensory recovery and fine motor dexterity. No significant differences were found between dominant and non-dominant limbs. Conclusions: Upper limb recovery follows a phase-specific evolution where motor strength provides the substrate for functional gains supporting a phase-specific approach to rehabilitation.