Stroke frequently results in long-term upper limb (UL) motor impairments, limiting independence and quality of life. Accurate prediction of recovery trajectories is essential for personalizing rehabilitation strategies. While structural brain metrics such as corticospinal tract (CST) integrity have been widely studied, they incompletely explain motor outcome variability. Functional brain activity, quantified by sensorimotor activity in the beta (β) frequency range has emerged as a promising biomarker of motor system integrity and plasticity potential. This study assessed in 30 acute stroke survivors and 26 healthy controls how combining functional and structural metrics of brain function relates to initial motor severity and subsequent recovery, using clinical MRI/CT and electroencephalography during passive finger movement and rest. Structurally, grey and white matter damage were associated with initial severity. No associations with recovery were found for structural metrics alone. Functionally, β-activity in response to passive movement, and resting state activity were related to recovery, independent of initial impairment. Multivariate regression revealed that combining initial severity, structural information (CST damage) and brain function (sensorimotor β activity) provided the most accurate prediction of both global and UL-specific recovery (R2 = 80.1% and 74.3%, respectively). These findings underscore the importance of integrating functional and structural neural markers for improved stroke outcome prediction. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study and CZ were supported by Brain Research UK (201718-13). L.C.M. was supported by the Medical Research Council (MR/N013867/1). This work was supported by a Senior Research Fellowship to Charlotte J Stagg by the Wellcome Trust (224430/Z/21/Z). This research was supported by the NIHR Oxford Health Biomedical Research Centre (NIHR203316). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The Centre for Integrative Neuroimaging (203139/Z/16/Z and 203139/A/16/Z) and the Centre for Human Neuroimaging (203147/Z/16/Z) were supported by core funding from the Wellcome Trust. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Research Ethics Committee of the University College London and the NHS Research Ethics Committee (London - Surrey Research Ethics Committee) approved the study protocol (20/LO/0520), and all subjects provided written informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.
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