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In the first few days after the occurrence of hemiplegia, the affected upper extremity is limp and appears flaccid, but actually, the muscles are spastic. After a variable short time a typical position is assumed. The upper extremity is adducted, the elbow flexed, the forearm pronated, and the wrist, fingers, and thumb flexed. If physical therapy and rehabilitation measures are not begun early, permanent contractures of muscles develop, and the upper extremity becomes fixed in the position described. There is a slow improvement in the brain tissue because of a partial resolution of the lesion. This results in improvement in the potential motor ability of the cortex. Unfortunately, this organic improvement of brain tissue cannot be translated into purposeful volitional movements, because the muscles and joints of the upper extremity have been fixed by contractures.
Many patients with hemiplegia of long duration have an increased potential ability to execute volitional
Rudin LN, Cronin DJ, Croucher JS. CORRECTIVE BRACE FOR THE UPPER EXTREMITY IN HEMIPLEGIA. JAMA. 1953;153(5):479. doi:10.1001/jama.1953.02940220023007