Neuromechanics of Nonuse and Compensation: Implications for Rehabilitation After Stroke.

The study included only patients with moderate upper limb impairment (Fugl-Meyer score median 40/66); findings may not apply to those with severe impairment or significant cognitive/perceptual deficits like neglect. The sample size was modest (22 per group). The study used a specific seated reaching task; results may not generalize to all functional activities. The 'healthy' model used a dumbbell to simulate weakness, which may not perfectly replicate the neural deficits of stroke. The clinical recommendations for treatment allocation are theoretical predictions based on these mechanics and have not yet been tested in prospective intervention trials.

Funding was provided by Nîmes University Hospital and LabEx NUMEV. The authors declared no potential conflicts of interest.

Do not interpret the reduction in compensation during arm support as proof that the patient has recovered strength. The study shows compensation is often a necessary effort-saving strategy; removing the load removes the need to compensate, but does not necessarily change the underlying capacity. Treatment allocation based on this framework is a hypothesis that requires prospective clinical trials to validate.