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La riabilitazione dopo un ictus cerebrale e efficace. Ha come obiettivo la stimolazione dei processi di plasticita cerebrale, la prevenzione delle complicanze secondarie e la restituzione della migliore autonomia possibile al paziente. Implica un lavoro di equipe specializzata, in condizioni ottimali in una struttura di medicina fisica e di riabilitazione. Fin dai primi giorni dopo l’ictus si tratta di prevenire la comparsa di complicanze, in particolare i dolori della spalla e le retrazioni muscolotendinee. La riabilitazione attiva inizia gradualmente a seconda dello stato del paziente e si basa su alcuni principi essenziali: la forte interazione sensibilita-motricita e cognizione-motricita, l’importanza di tener conto dell’individuo rispetto a se stesso e rispetto al suo ambiente, esercizi centrati sul compito da migliorare, la scelta di compiti che hanno un obiettivo significativo per il paziente, ripetizione dell’esercizio fino all’apprendimento, intensita crescente degli stimoli. Cosi, a seconda delle esigenze, la riabilitazione permette di migliorare la prensione, l’equilibrio, la deambulazione, la comunicazione o, ancora, i disturbi visuospaziali. I primi mesi dopo l’ictus sono essenziali, ma la riabilitazione puo essere necessaria anche oltre un anno dopo l’ictus e puo essere molto utile una sua ripresa tardiva.

Resume Introduction. – Il existe une dependance visuelle excessive chez les patients hemiplegiques a distance de leur AVC dont le mecanisme n'est pas certain. Le but de cette etude est d'evaluer l'importance et les caracteristiques de cette dependance visuelle precocement apres AVC. Methode. – Trente patients AVC hemispherique unique (14 G, 16 D), de moins de trois mois. L'âge, le delai, le cote, le siege et la taille de la lesion, l'autonomie (MIF), la motricite, la negligence et la sensibilite ont ete etudies. Chaque sujet a realise le rod and frame test ou il devait ajuster a la verticale une baguette d'abord isolee sans reference visuelle, puis au sein d'un cadre perturbateur incline de 18° a droite ou a gauche. Huit essais ont ete realises. La perturbation engendree par le cadre incline des patients a ete comparee a celle de 23 temoins comparables en âge et sexe et correlee aux caracteristiques du patient. Resultats. – Cinquante-six pour cent des patients etait visuodependants (17/30) contre 26 % (6/23) des temoins. La dependance visuelle n'etait pas liee a la lesion, la MIF, la motricite, le PASS, l'âge, la sensibilite ni la negligence. Discussion. – Il y a deux fois plus de dependants visuels apres AVC que dans la population temoin. Le mecanisme de cette dependance visuelle precoce est discute. Il parait necessaire de prendre en compte cette dependance visuelle excessive dans le programme de reeducation des patients AVC.

Resume Objectifs. – Identifier et decrire les echelles d'incapacites fonctionnelles utiles pour l'evaluation des patients hemiplegiques vasculaires. Preciser les instruments de mesure les plus utilisables en pratique clinique et ceux les plus utilises dans les essais cliniques. Methode. – Revue de litterature sur la base de donnees Medline en ciblant les parametres fonctionnels suivants : deambulation et marche, equilibre, fonction du membre superieur et independance dans les activites de vie quotidienne. Les parametres metrologiques des differents instruments de mesure sont precises, ainsi que leur utilite en pratique clinique quotidienne. Resultats. – Trente-trois outils de mesure ont ete analyses et classes en cinq categories : equilibre (6 outils), deambulation et marche (4), capacites fonctionnelles du membre superieur (11), echelles globales de motricite (5) et independance dans les activites de vie quotidienne (7). Discussion et conclusion. – Il existe de tres nombreuses echelles fonctionnelles utiles pour l'evaluation des patients hemiplegiques vasculaires. Elles ont toutes un interet propre. Pour mesurer l'equilibre, la Postural Assessment Stroke Scale et la Berg Balance Scale sont les plus interessantes. La Functional Ambulation Classification et la Timed Up and Go Test sont les plus pertinentes pour mesurer les capacites de deambulation et de marche. L'Action Research Arm Test est la plus utilisee pour mesurer les capacites fonctionnelles du membre superieur. La mesure de l'independance fonctionnelle et l'index de Barthel sont les plus reconnus pour l'independance dans les activites de vie quotidienne.

Background: Subjective visual vertical (SVV) perception can be perturbed after stroke, but its effect on balance recovery is not yet known. Aim: To evaluate the influence of SVV perturbations on balance recovery after stroke. Methods: 28 patients (14 with a right hemisphere lesion (RHL) and 14 with a left hemisphere lesion (LHL)) were included, 5 were lost to follow-up. SVV perception was initially tested within 3 months after stroke, then at 6 months, using a luminous line, which the patients adjusted to the vertical position in a dark room. Mean deviation (V) and uncertainty (U), defined as the standard deviation of the SVV, were calculated for eight trials. Balance was initially assessed by the Postural Assessment Scale for Stroke (PASS), and at 6 months by the PASS (PASS6), a force platform (lateral and sagittal stability limits (LSL6 and SSL6)), the Rivermead Mobility Index (RMI6) and gait velocity (v6). Functional outcome was also assessed by the Functional Independence Measure at 6 months (FIM6). Results: The scores for balance and for FIM6 were related to the initial V value: PASS6 (p = 0.01, τ = −0.38); RMI6 (p = 0.002, τ = −0.48), LSL6 (p = 0.06, τ = −0.29), SSL6 (p = 0.004, τ = −0.43), v6 (p = 0.01, τ = −0.36) and FIM6 (p = 0.001, τ = −0.49), as well as to the initial U value: PASS6 (p = 0.03, τ = −0.32), RMI6 (p = 0.02, τ = −0.35), SSL6 (p = 0.005, τ = −0.43) and FIM6 (p = 0.01, τ = −0.38). Conclusions: Initial misperception of verticality was related to a poor score for balance after stroke. This relationship seems to be independent of motricity and neglect. Rehabilitation programmes should take into account verticality misperceptions, which could be an important factors influencing balance recovery after stroke.

To examine the phenomenon of fatigue after stroke and to review the knowledge about frequency, consequences, associated factors, physiopathology and treatment.Medline was systematically searched with the following keywords: stroke, fatigue, sleep disorders, exercise, and rehabilitation. All relevant articles found in the references were screened as well.Fatigue is a common complaint after stroke and occurs in 39-72% of stroke survivors. Some studies show a severe functional impact of this symptom as well as a high mortality rate. Available evidence concerning associated factors is limited, but fatigue is clearly multifactorial. Some studies show that limited exercise capacity, increased gait energy cost, sleep-disordered breathing and sleep disorders can be related to physical fatigue. Other studies show a link between fatigue and depression. The existence of primary fatigue is still controversial. Treatment must follow a diagnostic approach. Treadmill training, among other treatments, improves fitness reserve and lowering of the energy cost of hemiparetic gait, which could be useful in relieving fatigue.

After chronic stroke, inability to use pertinent somatosensory or vestibular information have been described. The aim of the study was to determine whether visual dependence occurred early after stroke before rehabilitation.Thirty patients with recent hemiplegia (16 right and 14 left hemispheric stroke) performed the rod and frame test (RFT). Patients were asked to adjust the rod to the vertical position under 3 conditions: basically, with a frame tilted 18 degrees to the right and then with the frame tilted to the left. Bias in each condition (mean, SD) was recorded and compared to adjustments of the rod by 23 controls. Motor control, sensibility, functional level (functional independence measure), age, neglect, and then balance by the postural assessment scale for stroke were assessed.Fifty-six per cent (17/30) of patients but only 26% of controls were influenced by the tilt of the frame on the 2 sides (visual dependence). No correlation was found between visual dependence and the characteristics of the patients.Many patients with recent hemiplegia seem to rely on visual input. The mechanisms of such visual dependence are discussed. Rehabilitation programs should take into account the possible impairment of sensory organisation and should include exercises to be performed under visual disturbances.

To identify and describe the most useful functional disability scales for assessing post-stroke hemiplegic patients and those used largely in clinical trials.A literature review of Medline about the functional parameters for balance, gait and mobility, upper extremity functional abilities, and activities of daily living. The metrologic properties of the scales were specified as were their clinical use.Thirty-three scales were evaluated and classified into five categories: balance (6 scales), gait and mobility (4), upper limb function (11), global motricity scales (5) and independence in activities of daily living (7).Many functional scales are useful for assessing post-stroke hemiplegic patients. To assess balance, the Postural Assessment Stroke Scale and Berg Balance Scale are the most interesting. The Functional Ambulation Classification and the Timed Up and Go Test are the most relevant to assess gait and mobility. The Action Research Arm Test is largely used to assess upper limb functional abilities. The Functional Independence Measure and the Barthel Index are largely used to assess independence in activities of daily living.