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Background and Purpose— Intensive physical therapy (PT) facilitates motor recovery when provided during a subacute stage after stroke. The efficiency of very early intensive PT has been less investigated. We aimed to investigate whether intensive PT conducted within the first 2 weeks could aid recovery of motor control. Methods— This multicentre randomized controlled trial compared soft PT (20-min/d apart from respiratory needs) and intensive PT (idem+45 minutes of intensive exercises/day) initiated within the first 72 hours after a first hemispheric stroke. The primary outcome was change in motor control between day (D) 90 and D0 assessed by the Fugl–Meyer score. Main secondary outcomes were number of days to walking 10 m unassisted, balance, autonomy, quality of life, and unexpected medical events. All analyses were by intent to treat. Results— We could analyze data for 103 of the 104 included patients (51 control and 52 experimental group; 64 males; median age overall 67 [interquartile range 59–77], 67 right hemispheric lesions, 80 ischemic lesions, National Institutes of Health Stroke Scale score ≥8 for 82%). Fugl–Meyer score increased over time ( P P =0.29) or interaction between treatment and time ( P =0.40). The median change in score between D90 and D0 was 27.5 (12–40) and 22.0 (12–56) for control and experimental groups ( P =0.69). Similar results were found for the secondary criteria. Conclusions— Very early after stroke, intensive exercises may not be efficient in improving motor control. This conclusion may apply to mainly severe stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01520636.

The usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.This was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.We reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%-10%; P0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P0.05).Disabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.

Objective: To investigate the weight of visual and proprioceptive inputs, measured indirectly in standing position control, in patients with chronic acquired demyelinating polyneuropathy (CADP). Design: Prospective case study. Subjects: Twenty-five patients with CADP and 25 healthy controls. Methods: Posture was recorded on a double force platform. Stimulations were optokinetic (60°/s) for visual input and vibration (50 Hz) for proprioceptive input. Visual stimulation involved 4 tests (upward, downward, rightward and leftward) and proprioceptive stimulation 2 tests (triceps surae and tibialis anterior). A composite score, previously published and slightly modified, was used for the recorded postural signals from the different stimulations. Results: Despite their sensitivity deficits, patients with CADP were more sensitive to proprioceptive stimuli than were healthy controls (mean composite score 13.9 ((standard deviation; SD) 4.8) vs 18.4 (SD 4.8), p = 0.002). As expected, they were also more sensitive to visual stimuli (mean composite score 10.5 (SD 8.7) vs 22.9 (SD 7.5), p

Objective The positive effects on motor cortical excitability of stimulating proprioception with tendon vibration therapy have previously been reported in healthy individuals and in chronic stroke patient (Marconi et al., 2008 and 2011). The aim of this study is to evaluate the feasibility of a protocol of tendon vibration therapy in a neurorehabilitation service, with a view to proceeding to an efficacy study. Material/Patients and methods We performed a prospective, single-centre study, including 11 patients, 8 men, mean age 61,7 ± 10,6, with upper limb motor deficit secondary to a first stroke (5 ischaemic). Average time post-stroke was 116.8 days. Mean NIHSS at inclusion was 7,9 ± 5,7. Two 15-minute sessions per day for 5 days of vibration therapy associated to voluntary movement were applied to the elbow and wrist flexor and extensors of the hemiplegic arm. The vibration therapy was in addition to standard rehabilitation. The feasibility was assessed by the implementation of the protocol (logistic regression of sessions, who did it? Where? When?), adverses outcomes and tolerance. Assessment of motor function at baseline and at day 7 was performed with Fugl-Meyer (upper limb), ARAT, Box and Blocks Test and ARMEO was used to assess the volume of exploration of the arm. Functional recovery was measured by the difference between the two scores. Results Nine patients were eligible (1 transferred to another ward for a septicaemia; 1 incomplete assessment at day 7). 97.7% of planned vibration sessions were performed. There were no adverse outcomes. Treatment was well tolerated; 1 patient reported transient paraesthesias and 4 patients reported significant fatigue whilst undergoing therapy. Every patient improved motor control: mean delta (±SD): ARAT: +8.6 points ± 14.2; BBT: +3.5 points ± 10.8; Fugl Meyer: +3.3 points ± 4.2; volume of exploration ARMEO: +38% ± 75.1%. Discussion - Conclusion This preliminary, open-labelled, study demonstrates that this protocol is achievable in a neurorehabilitation clinic setting. Given the functional improvement seen, randomised controlled trials should be performed to further evaluate the effects on motor control.

Objective Music therapy enhances awareness of sound perception and musical sensorial experience often highly impaired following a stroke, confirmed by music's neurosciences. The study aims to verify its reception and utility in a Physical Medicine and Rehabilitation (PMR) service with professional team and patients. Material/patients and methods Eleven hospitalized patients were included after stoke (without regular instrumental practice, speech disorder, severe hearing loss nor psychiatric history). They were followed by a music therapist, twice a week, during 40 minutes’ individual sessions with improvisation and music listening, from October 2015 to April 2016 with an instrumentarium. The study consisted of analysing self-administered questionnaires, both to patients (after each session) and professionals, on the feeling and the impact on the primary activity of the service. Results Thirty-one returned questionnaires among the 47 caregivers indicate that sessions were simple to implement (81%) and carried low restrictive measures (94%). For 90%, music therapy can be easily integrated into the course of the day. For 96%, it did not obstruct the proper functioning of the service. Hundred percent believed that it can be helpful for the patient and can improve practices in PMR. Seventy-three percent noticed an improvement in patients, in particular mood, motivation and self-esteem. Hundred and ten sessions were carried out and appreciated by patients. Ninety-eight percent replied that they felt more relaxed, calm, alert, awake, a feeling of well being and rested. Discussion - conclusion Patient compliance and reaction of the team were excellent. Moreover, it was observed that, over the sessions, there had been a progressive development in listening abilities, in creativity and an improvement in rhythmic and melodic skills. Although they were not quantified, it encourages us to continue the study.