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Introduction Sleep apnea syndrome (SAS) frequently occurs after a stroke. Its association with a poor prognosis is open to discussion. Objective To study, in a physical and rehabilitation medicine (PRM) unit, the possible repercussions of SAS on neurological and functional recovery as well as attentional abilities following a stroke. Patients and methods Forty-five patients, all of whom had recently had a stroke without previously documented SAS, were screened using the ApneaLink® system. An apnea-hypopnea index (AHI) score ≥10 was considered as indicative of SAS. The NIHSS, Fugl-Meyer (FM) and Functional Independence Measure (FIM) Scales were applied on admission and at two months as means of assessing neurological and functional recovery, which was expressed by the difference between the first and the second scores (delta FM, delta NIHSS, delta FIM). The Battery Attention William Lennox (BAWL) Test was given once in order to evaluate attention disorders. SAS severity was categorized according to the AHI. We compared the groups formed (mild, moderate and severe) using the same method. Results Twenty-eight patients (62.2%) presented AHI ≥ 10. Stroke characteristics were comparable in the SAS+ and the SAS– groups, with average post-stroke time lapse of 26 days, initial average FIM score of 71.2 points ± 26.3 and initial average NIHSS score of 8.9 ± 4.9. The demographic characteristics of the two groups were likewise comparable with the exception of age, as the SAS+ group was pronouncedly older (65.4 vs. 53.5 years). As for delta FIM, which evaluated functional recovery, it averaged 31.8 ± 20.6. Cases of SAS were found to be mild (37.1%), moderate (28.6%) or severe (34.3%). No significant difference was observed on admission or at 2 months as regards the clinical scales or the BAWL test between the two groups or according to severity, except for the NIHSS score at 2 months in the severe sub-group. Discussion and conclusion This study did not demonstrate the supposed repercussions of SAS on the recovery or attentional abilities of post-stroke patients. The tests were maybe given too early; they should take place at a lengthier time interval after the stroke, and also to be more complete.

The functional consequences of spasticity can be corrected by local, pharmacological or surgical treatments once the spastic muscle has been identified. However, this diagnosis can be tricky when the muscle in question is rarely involved in spasticity or when its mechanical action is unusual or poorly characterized. Here, we present the case of a man presenting with left hemiplegia after an ischaemic stroke. His gait was perturbed by foot clonus in the sagittal plan, which persisted after selective neurotomy of the gastrocnemius and soleus but disappeared after neurotomy of the peroneus longus. Clonus triggered by pushing up under the whole of the forefoot in the direction of dorsiflexion may not be related to spasticity of the triceps surae. We recommend screening for foot clonus by first pushing up on the sole of the foot under all five metatarsals. In a second step, selectively pushing up under the first metatarsal joint enables the physician to evidence spasticity of the peroneus longus.

Objective To study work re-entry by patients having suffered a stroke at least 3 years previously. Patients and methods This was a retrospective survey in which a questionnaire was administered to all patients admitted after a first stroke to the “La Tour de Gassies” Centre for Physical and Rehabilitation Medicine (CPRM) in France between January 2005 and June 2007 and who were in work at the time of the incident. Results Fifty-six of the 72 included patients (78%) completed and returned the survey questionnaire. The mean age at the time of the stroke was 48.3 ± 10.1. Eighteen (32.1%) of the 56 patients returned to work after their stroke (mean post-stroke time interval: 19.2 ± 13.4 months). Negative prognostic factors for a return to work were living alone, the presence of severe functional impairment and the presence of speech disorders. Positive prognostic factors included specific, professional support and early involvement of the occupational physician. Patients who resumed driving were more likely to return to work and there was a positive correlation between the time to work re-entry and the time to resumption of driving. Conclusion Close cooperation between occupational health services and CPRM appears to be necessary to speed the return to work by stroke patients.

Background. – After stroke, the early and persistent decline in aerobic capacity leads to diminish walking capacities. The aim of the study is to investigate the effects of aerobic cycloergometer interval-training on the walking performances in subacute and chronic stroke survivors. Method. – A prospective design was used. Fourteen patients whose stroke had occurred more than 3 months and less than 2 years performed an aerobic training session with a cycloergometer for 8 weeks. A maximal exercise test, a 6-min walking test, a 20-m test and an isokinetic muscle strength test were realized before and after training session. Results. – There was a significant increase after aerobic training in maximal power (Pmax) (mean 23.2%, P < 0.0001), in VO2peak (mean 14.8%, P = 0.04), and in the knee extension and flexion muscle peak torque on the nonparetic side and extension on the paretic side in isokinetic mode (mean from 13 to 29%, P = from 0.019 to P = 0.0007) and in the walking performances on the 6-min walk test (mean 15.8%, P = 0.0002). Conclusion. – Patients with subacute and chronic stroke can improve aerobic capacity, muscle strength and walking performances after cycloergometer interval-training. Although these results must be interpreted with caution considering the small size of our sample, they suggest that aerobic training is a safe and potentially effective training after stroke and an alternative to walking treadmill training. # 2010 Elsevier Masson SAS. All rights reserved.

Objectives To observe whether medical complications, the evolution of neurological disorders and dependence and/or the discharge destinations are different for patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery compared to patients treated medically for severe or malignant cerebral infarction in the same cerebral territory, during their hospitalization in a physical medicine and rehabilitation department. Patients and methods This retrospective study compared patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery and patients treated medically for severe or malignant cerebral infarction in the same cerebral territory. Patients were paired according to age, lesion side and hospitalization period. Results Twelve patients treated by craniectomy (age 43 ± 10.44) were paired with 12 patients treated medically (age 49 ± 7.66). The two groups were comparable in terms of general undesirable medical events. The medical events related to craniectomy are described. The evolution of patient deficiencies, the length of the hospital stay (194 ± 118.93 days vs 152 ± 94.64 days), the Functional Independence Measure at discharge (87 ± 21.28 vs 95 ± 22.19) and the number of direct home discharges (7 vs 9) did not significantly differ between groups. Discussion and conclusion No more medical problems were observed in the patients treated by craniectomy than in the patients treated medically, except for the medical events specifically related to craniectomy, which extended the hospital stay but had no major repercussions.

The objective is to define as early as possible appropriate criteria for managing patients who have had a cerebrovascular accident (CVA), or stroke, beginning in the Neurovascular and Acute Care Services, in order to facilitate the patient's return home (or the equivalent of home) or continuing care in the most appropriate health care facility.Three clinical assessment tools are used in the initial care phase because they are robust and reproducible:– the National Institutes of Health Stroke Scale (NIHSS) score appears to be the best clinical assessment tool. It is the reference scale used during the acute phase of a stroke because it predicts the patient's chances of recovery and the medium-term functional recovery;– the Glasgow Coma Scale (GCS) is an initial assessment tool useful in predicting the medium-term evolution in terms of level of consciousness, essentially in cases of cerebral hemorrhage or severe cerebral infarction;– the Barthel Index (BI), scored from 0 – 100, is used during the first seven days after a stroke, and the index's progression over the following two weeks is a factor in predicting the functional recovery of stroke patients.The values of these tools must take the markers of clinical stability into account during the initial phase. These markers also have a predictive value:– the curve of the relationship between blood pressure (BP) and the prognosis of stroke patients would have a U-shape, with extreme BP values having a negative influence;– hyperthermia and hypoxia are also early predictive factors of poor functional and vital prognoses;– the presence and continuation of urinary incontinence and/or swallowing disorders are important predictive factors for a poor functional prognosis and a higher mortality rate in the medium term.Complementary examinations make it possible to approximate the anatomical, metabolic and physiological status of the injured cerebral parenchyma early on, when the processes of reparation and plasticity restoration have already begun. The reparation process is a complex multifactor phenomenon that can, at any moment, be called into question; it cannot be predicted with certainty by complementary examinations only, at least at the current level of knowledge.Two parameters seem decisive in using imaging to predict stroke recovery: MRI exploration of the cerebral parenchyma and the exploration of vascular permeability via perfusion imaging. Currently, the place of functional and molecular imaging appears to be limited. Among the possible neurophysiological explorations, only motor evoked potentials (MEP) represent a simple, non-invasive, low-cost procedure that can have additional prognostic value. Hyperglycemia also has a negative impact on the functional and vital prognoses. The usefulness of biomarkers has not yet been validated.Other clinical factors influence the prognosis. Though age is an aggravating factor in the vital prognosis of stroke patients, it cannot be considered an independent factor in the functional prognosis due to the multiple co-morbidities associated with age. Diabetes, ischemic cardiopathies and atrial fibrillation are co morbidities that worsen the functional and vital prognoses of stroke patients.Cognitive disorders without dementia also have a negative influence on the functional prognosis, particularly hemi spatial neglect and phasic disorders accompanied by comprehension problems. Post-stroke dementia plays a very detrimental role. However, even though they can delay the acquisition of increased autonomy, cognitive disorders are not an obstacle for rehabilitation, and depression apparently has no influence on the rehabilitation results.Family is an essential factor. Family support is a necessary condition for the patient's discharge from the hospital and affects the length of the hospital stay. Wide-ranging effective organized family support improves the patient's functional status. The factors that make it possible for the patient to return home are the existence of home support, a moderate level of impairment and being of the masculine gender. Social rank and socioeconomic status also play a role: when rank and status are low, they are not only stroke risk factors but also increase the risks of poststroke mortality and of institutionalization.For the health care system to perform well, stroke management plans must respect two requirements:– individual requirement: the best possible match between the patient's needs and possibilities and the follow-up services, without missing any patient opportunity for an optimal return to normalcy;– organizational requirement: early intervention and the optimal transfer time in order to insure system flexibility and make it possible for the greatest number of patients to benefit from care in a specialized facility, particularly during the acute phase of the stroke.Patients will preferably be directed towards:– an intermediary or Intensive Care facility and then a rehabilitation facility specialized in brain injuries. Patients with severe impairment (NIHSS over 16), when they are conscious and off artificial ventilation, with or without a tracheotomy; malignant stroke patients, postdecompressive hemicraniectomy; and stroke patients with basilar trunk occlusion, after thrombolysis recanalization;– a follow-up and rehabilitation care facility specialized in neurological disorders. Patients with medium-level hemiplegia (NIHSS between 5 and 15 and/or Barthel Index≥20) who begin to improve in the first 7 days and younger patients with more serious hemiplegia if there is no rehabilitation facility specialized in brain injuries nearby;– a non-specialized follow-up and rehabilitation care facility or one that is specialized in the disorders of polypathologic elderly patients who are dependent or at risk of being dependent. Patients with serious hemiplegia without any signs of recovery in the first 7 days, who have multiple indicators of a poor prognosis (Barthel Index45).Two factors are essential for the success of such early returns home:– a home visit carried out before the patient's discharge;– a multidisciplinary team (physiotherapists, occupational therapist, speech therapist, doctor, nurse and social worker) who, at the end of the patient's hospital stay, takes responsibility for appropriate patient care immediately following the patient's discharge, for a period of approximately three months and a minimum frequency of four sessions per week.The Early Supported Discharge (ESD) model developed in Anglosaxon countries, which facilitates and conditions this kind of discharge plan, does not correspond exactly to the French health system's Hospitalisation à domicile (HAD), but the correspondence between the two is worth exploring. In the absence of a multidisciplinary intervention, the early long-term intervention (at least 5 months) of an occupational therapist in the patient's home can reduce the patient's level of impairment after an early return home (less than 1 month after the stroke).Maintaining the patient in his/her home starts by identifying the needs of both the patient and the caregivers, updating these needs as the situation evolves. The multidisciplinary team plays an important role in maintaining, even increasing, the patient's autonomy, and improving the patient's quality of life and that of his/her caregivers, while ensuring an optimal level of safety in the home. This is accomplished by educating both the patient and caregivers and by home interventions. The failure to maintain the patient at home can be caused by the worsening of the patient's condition (e.g., intercurrent disorders, loss of autonomy) or unpredictable factors (e.g., death of the patient's spouse), but also by the exhaustion of the patient's caregivers.When patient autonomy backslides or the patient loses interest, the intervention of a multidisciplinary team in the home of the stroke patient can help to reduce the deterioration rate of the activities of daily living (ADLs) and increase the patient's capacity to do personal activities. This intervention consists of repeat visits in the three months that follow the patient's discharge from the hospital. The health care providers and the caregivers need information about transfer techniques, adapting and using technical aids, fall prevention and the development of safety strategies for the home, improving communication difficulties, and adapting to the patient's visual disturbances and emotional changes. In the absence of a structured multidisciplinary team, occupational therapy can have a positive effect on personal and instrumental ADLs and social participation. Physiotherapy in the home alone doesn’t seem to have a significant effect on the patient's functional capacities.

Most studies of functional outcomes in hemiplegic stroke patients use standard disability rating scales (such as the Barthel Index). However, planning the allocation of assistance and resources requires additional information about these patients’ expectations and needs. Aims of the study To assess functional independence in daily living and house holding, changes in home settings, type of technical aid and human helps, and expectations in hemiplegic patients 1 to 2 years after the stroke. Methods Sixty-one out of 94 patients admitted to the neurovascular unit of French university hospital for a first-ever documented stroke were consecutively enrolled. The study was restricted to patients under 75, since patients over 75 do not follow the same care network. Patients were examined at their homes or interviewed by phone 17 months (on average) after the stroke. Standard functional assessment tools (such as the Barthel Index and the instrumental activities of daily living [IADL] score) were recorded, along with descriptions of home settings and instrumental and human help. Lastly, patients and caregivers were asked to state their expectations and needs. Results Although only one person was living in a nursing home after the stroke, 23 (34%) of the other interviewees had needed to make home adjustments or move home. Seven patients (11%) were dependent in terms of the activities of daily living (a Barthel Index below 60) and 11 (18%) had difficulty in maintaining domestic activities and community living (an IADL score over 10). Although the remaining patients had made a good functional recovery, 23 were using technical aids and 28 needed family or caregiver assistance, including 23 patients with full functional independence scores. Twenty-five patients (42%) were suffering from depression as defined by the diagnosis and statistical manual of mental disorders (4th edition, text revision, DSM IV-R). The patients’ prime concerns were related to recovery of independence, leisure activities and financial resources. Family members’ expectations related to the complexity of administrative matters, lack of information and the delay in service delivery. Discussion and conclusion In under-75 hemiplegic stroke patients, high scores on standard disability rating scales do not always mean that no help is required.

Objectives The goal of early supported discharge (ESD) is to reduce the duration of in-patient care in stroke units (SUs) and to optimize the management of pre- and post-discharge rehabilitation. Here, we report on and discuss ESD's effects on various outcome parameters in stroke patients. Methods Analysis of randomized, controlled studies and meta-analyses identified in the Medline and Cochrane databases. Results ESD interventions have been evaluated in more than 10 studies. Most of the included patients had suffered from mild or moderate strokes. Meta-analyses have shown that when compared with standard care, ESD has a positive effect on the risk of death or institutionalisation, death or dependence and participation in instrumental activities of daily living (iADL). In-patient hospitalization in the SU and the overall cost of care were significantly lower. Individual studies showed variability in the inclusion criteria, type of care, comparisons performed and conclusions drawn. ESD's superiority in terms of the risk of death or dependency was mainly reported in a Norwegian study and that in terms of iADL was reported in a Swedish study. There was no specific effect on functional impairment and personal ADL (pADL). Discussion This technique reduces the length of the in-patient stay and the overall cost of care while lowering the risk of death or institutionalisation and promoting participation in iADL. However, studies on this topic are heterogeneous.

In stroke patients with severe persistent neurological deficits, alternative therapeutic modalities are limited. Stem cell therapy might be an opportunity when the safety profile of this approach will be achieved. This review will give possible mechanisms of restoration of function in animals and a statement of clinical trials in humans. The sources of neural stem cells for therapeutic use will be detailed. Potentials mechanisms of transplanted cell-mediated recovery are described with a particular emphasis on ipsilesional post-stroke plasticity. The optimal conditions for cell transplant therapy after stroke are evoked but not yet clearly defined. Finally, since multimodality imaging will be crucial in the post-transplantation patient assessment, the final part describes recent advances in the in vivo monitoring of repair progress.

presentant une aphasie totale (score ASRS de Goodglass et Kaplan a 0) n’a pu passer l’entretien. Celui-ci a ete difficile chez 3 patients (deux ASRS 1, un ASRS 2), possible avec reformulations chez 16, et facile chez les 12 autres. Il existe des differences significatives avec les scores des temoins dans 5 des 6 categories CIF notamment pour les itemsRP entretien du linge, deplacements exterieurs, courses et achats, budget, relations avec des inconnus, loisirs de groupe, vie associative et demarches administratives. Parmi les facteurs d’environnement, le soutien social est juge satisfaisant dans 79,5%des situations. Les attitudes des autres sont jugees 3 a 4 fois plus souvent facilitatricesqu’obstacles. Le facteurSystemeset politiques est facilitateur pour Soins personnels, Vie domestique, Vie communautaire, mais plutot obstacle pour Relations et Loisirs. Discussion.– La GMAP est applicable a la plupart des personnes aphasiques, mais des versions multi-sources seront utiles chez ces patients. Le modele CIF parait pertinent pour comprendre leurs difficultes de participation. Reference [1] Belio C, Prouteau A, Koleck M, Saada Y, Merceron K, Destaillats JM, et al. Participation in patients with psychic and/or cognitive impairments. Annals PRM 2013 [in print]..

Mots cles : Heminegligence ; Accident vasculaire cerebral ; Stimulation cerebrale ; TDCS Problematique.– Le syndrome d’heminegligence est une deficience frequente consecutive a un accident vasculaire cerebral. Parmi les theories explicatives de ce syndrome, le concept de competition interhemispherique est evoque [1]. Toute intervention visant a modifier cet equilibre pourrait presenter un interet dans le traitement de la negligence. Les stimulations cerebrales non invasives (transcranial Direct Current Stimulation [tDCS] et repetitive Transcranial Magnetic Stimulation [rTMS]) ont montre leur capacite a moduler l’excitabilite cerebrale [2]. Ces techniques ont peu ete evaluees dans cette indication ; les travaux publies concernent essentiellement la rTMS [3,4]. Materiel et methodes.–Dans cette etude pilote, nous avons tente de repliquer en tDCS les resultats obtenus en rTMS. Deux patientes ont beneficie, lors de deux sessions, d’une tDCS parietale gauche soit inhibitrice soit placebo. Les performances dans des tâches visuoperceptives (bissection de lignes et test des cloches) ont ete evaluees avant, pendant et apres la stimulation. Resultats.– Pour l’une des patientes, le biais de bissection a diminue pendant la stimulation reelle (biais de 0,8 % contre 18,5 % en pre-test) mais pas placebo (22,4 % contre 17,3 %) ; l’exploration visuelle etait meilleure (+30 % de cibles identifiees, –4,1 % en condition placebo). Pour la seconde patiente, le biais de bissection etait stable ; l’exploration visuelle etait meilleure apres stimulation reelle (+26 % de cibles, –3,2 % en condition placebo). Discussion.– Ces premiers resultats confirment la possibilite d’une amelioration des performances depatients heminegligents pendant une stimulation.Unnombre plus important de patient est necessaire afin de confirmer ces premiers resultats.

Stroke is a major public health issue. Even though most hemiplegic stroke patients may obtain a good functional outcome, many remain dissatisfied with their lives. Indeed, quality of life and subjective well-being should be taken into account in any assessment of stroke survival. Objective To assess long-term quality of life in stroke patients (compared with healthy controls) and the corresponding determinants and predictive factors. Method The patient population consisted of 80 of the 217 first-stroke survivors treated between January and June 2005 in the Clinical Neurosciences Department at Bordeaux University Hospital. After a mean follow-up period of 2 years, 24 patients were interviewed in their homes and data from the 56 others were obtained in a telephone interview. Demographic information, clinical status on admission and functional status (as assessed by Barthel Index) and depression (on the ADRS) at the time of the study visit were recorded. Quality of life was assessed by using the Sickness Impact Profile (SIP-65) and Branholm and Fugl-Meyer's Satisfaction with Life Scale (LiSat 11). The patients' data were compared with those from 149 healthy controls. Results Life satisfaction and quality of life were significantly impaired in stroke patients, compared with controls. All life domains were impaired. The worst scores were observed for independence and health-related items in the LiSat 11 and the physical and communication items in the SIP-65. Quality of life was strongly correlated with functional independence, the persistence of hemiplegia and depressive mood, which is in agreement with literature findings. Neither gender nor the initial Rankin score had a significant impact on these parameters. Discussion-conclusion Quality of life at 2 years is significantly impaired in stroke survivors and seems more difficult to predict than functional independence. However, in addition to these objective results, our interviews suggest that receiving adequate social support might be as important to patients as recovering independence.

International audience; BACKGROUND: Clinical outcomes and socioeconomic consequences after a stroke may differ between regions. METHODS: One cohort was established prospectively in Kunming (China) to compare with a cohort of 156 stroke patients included in Limoges (France). During 1 year, patients hospitalized within 48 hours for a first-ever hemispheric stroke were included. Demographic data and neurocardiovascular risk factors were registered. Hemiplegia was evaluated. Functional outcome was assessed using the Barthel Index (BI) after 3 months. RESULTS: One hundred and eighteen patients were included in Kunming. Patients of Kunming were younger (61.4 ± 13.4 vs 72.3 ± 14.6 years in Limoges, P70 years (HR=6.29, 95% CI [2.36, 16.59]). Despite a better baseline BI for patients of Kunming (50.0 ± 34.9 vs 37.4 ± 34.2, P=0.0031), after adjustment for confusing, patients in Limoges had a 2.11 OR 95% CI [1.03, 4.31]) to reach a BI>80 at 3 months. CONCLUSIONS: Functional recovery for patients of Kunming was not as good as expected. The socioeconomic consequences of stroke in Kunming are significant as they involved younger subjects who were still in work.

Mots cles : Griffe des orteil ; Accident vasculaire cerebral Objectifs.– La griffe d’orteil est une affection frequente et invalidante chez les patients hemiplegiques. Malheureusement en France, il n’existe ni recommandations ni consensus sur son traitement. L’objectif de ce travail est de proposer aux reeducateurs une grille de decision consensuelle afin de faciliter la decision dans la prise en charge des griffes d’orteil. Methode.– Dans un premier temps, nous avons construit un schema decisionnel sur l’attitude vis-a-vis d’une griffe des orteils en synthetisant les donnees de la litterature et l’experience du service de MPR de Toulouse. Ensuite, nous avons fait evaluer cet arbre decisionnel par des medecins nationaux experts dans ce domaine, afin de proposer une grille decisionnelle consensuelle. L’evaluation concernait, tout d’abord, la qualite globale de l’arbre decisionnel et la realisation d’un bloc nerveux a la xylocaine avant la realisation d’une injection de toxine botulique. Puis, dans le cadre d’une participation des muscles intrinseques a la griffe, objectivee par un bloc du nerf tibial posterieur a la cheville positif, etait analyse le choix des muscles a toxiner : court flechisseur des orteils ou carre plantaire. Enfin, la prescription d’un traitement orthopedique par semelles avec appui retrocapital etait evoquee. Resultats.– Ce sondage a suscite un reel interet de la part des experts contactes avec un taux de reponse de 100 % dans des delais tres courts. Globalement, cette grille decisionnelle est partagee par la plupart des experts choisis qui evalue son utilite a 6/10. Ils proposent majoritairement un traitement par semelles avec appui retrocapital et n’effectuent pas souvent de bloc nerveux avant de toxiner. De plus, en cas de participation des muscles intrinseques a la griffe, ils ont plus l’habitude de toxiner le muscle court flechisseur des orteils. Discussion.– La realisation de cette enquete a permis soulever la problematique medicolegale des blocs consideres par l’ASFAR comme des actes d’anesthesie, alors que de nombreux MPR le font dans leur service. Enfin, d’un point de vue methodologique, il serait interessant de renouveler cette demarche pour faciliter la prise en charge des principales deficiences des patients hemiplegiques comme le stiff-knee ou le varus equin.

Introduction In spatial neglect, the functional benefit of rehabilitation methods is subject to debate. A few studies have reported that galvanic vestibular stimulation (GVS) is efficacious in spatial neglect. The objective of the present study was to establish whether the effects of GVS persist after the end of stimulation. Materials Four patients with pathological rightward deviation in a bisection task at least three months after right hemisphere stroke. A single-blind, randomized crossover design was used to assess the effects of GVS on performance in line bisection and star cancellation tasks under three different conditions (cathode-right, cathode-left and sham stimulation). Results There were no significant differences in the performance of either task following GVS (relative to sham stimulation). Conclusion Galvanic vestibular stimulation did not reduce spatial neglect symptoms in any of the stimulation conditions. Further studies are necessary to understand the disparity between our results and those reported in the literature. Repeated sessions, a higher current intensity and/or alternating-current stimulation may improve this method before it can be used clinically.

Innovative technologies for sensorimotor rehabilitation after stroke have dramatically increased these past 20 years. Based on a review of the literature on “Medline” and “Web of Science” between 1990 and 2013, we offer an overview of available tools and their current level of validation. Neuromuscular electric stimulation and/or functional electric stimulation are widely used and highly suspected of being effective in upper or lower limb stroke rehabilitation. Robotic rehabilitation has yielded various results in the literature. It seems to have some effect on functional capacities when used for the upper limb. Its effectiveness in gait training is more controversial. Virtual reality is widely used in the rehabilitation of cognitive and motor impairments, as well as posture, with admitted benefits. Non-invasive brain stimulation (rTMS and TDCS) are promising in this indication but clinical evidence of their effectiveness is still lacking. In the same manner, these past five years, neurofeedback techniques based on brain signal recordings have emerged with a special focus on their therapeutic relevance in rehabilitation. Technological devices applied to rehabilitation are revolutionizing our clinical practices. Most of them are based on advances in neurosciences allowing us to better understand the phenomenon of brain plasticity, which underlies the effectiveness of rehabilitation. The acceptation and “real use” of those devices is still an issue since most of them are not easily available in current practice.