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Objective: To demonstrate the feasibility and efficacy  of a new video-observation training method (intensive visual simulation) to improve upper limb function., Design: Small sample, randomized, evaluator-blind, monocentric study., Patients: Seventeen early subacute ischaemic stroke patients with complete hemiplegia were  randomly assigned to the therapeutic group (n = 8) or control group (CG, n = 9)., Methods: Thirty sessions of intensive visual simulation combined with corrected visual feedback (therapeutic group) or uncorrected visual feedback (control group) were performed over 6 weeks on top of a standard rehabilitation programme., Main Outcome Measure: 400-point hand assessment test (400p-HA)., Secondary Outcome Measures: Box and Blocks (B&B), Purdue Pegboard test, Minnesota., Results: The 400p-HA test improved significantly from T0 to 6 months for both groups, with a significant difference between groups at 3 months (MW-UT p = 0.046) and 4 months (MW-UT p = 0.046) in favour of the therapeutic group. One-phase exponential modelling of 400p-HA showed a greater plateau for the therapeutic group (F test p = 0.0021). There was also faster recovery of the ability to perform the B&B tests for the therapeutic group (log-rank test p = 0.03)., Conclusion: This study demonstrated the feasibility and potential efficacy of an intensive visual simulation training programme to improve upper limb  function in subacute stroke patients. A larger study is needed to confirm these results.

Introduction: Physical medicine and rehabilitation (PMR) can involve the care of cancer patients requiring rehabilitation for associated deficiencies. In this case, rehabilitation methods may differ due to the evolutive nature of the disease., Objective: To reflect on this aspect of PMR based on real cases., Method: Cases study of patients hospitalised in the PMR unit for neurological rehabilitation and diagnosed with cancer., Results: Twenty-four recorded cases (1998-2006); four cases are described because of difficult problems; in only seven cases the coexisting cancer had no impact on the rehabilitation process., Discussion and Conclusion: Supportive care for patients with a bad vital prognosis differs from standard rehabilitation and raises therapeutic and relational issues not commonly faced in PMR. Responses when confronted with a terminal disease are not the same as when confronted with a handicap. The role of the rehabilitation team is brought into question when functionality is of secondary importance. The response to physical pain is different in rehabilitation and often implies a behavioural approach, which requires the commitment of the patient to therapeutic programmes. We do not find this approach in oncology and the treatment of pain uses first some drugs. Supportive care of these patients requires a close working relationship with the oncology unit. Thus, a different approach must be taken to rehabilitation. It should always take into account the evolutive nature of cancer, which can undermine the patient's functions or setback the patient's recovery. It also requires the support of a care team, which is fully prepared for these setbacks.