[Medico-social problems in the recovery from stroke]

Until a few years ago physicians were not rehabilitation-oriented, but recent discoveries regarding the plasticity of the nervous system have made the patient with an acute cerebrovascular lesion a clinical model of great interest. Furthermore, the severity of the frequent residual invalidities and the high social costs are the reasons why this field of medicine is becoming increasingly important. The clinical study of stroke has not changed much during the past century. Perhaps our semeiological abilities are not the same but we have improved our knowledge of the neurosciences and we know that in the acute phase we have to look towards the patient's future and not only at his current condition. A certain degree of recovery occurs immediately after stroke thanks to the resolution of secondary events such as edema and ischemia. Other factors that may have important effects on recovery include the localization, nature, extension and degree of brain damage, the patient's sex and age, the duration of coma, the patient's original cognitive capacity, his personality and motivation as well as the duration and intensity of rehabilitation and the time before starting rehabilitation. Many of these variables are difficult to check in trials performed in humans. Statistical problems make it difficult to prove any beneficial effect of rehabilitation. Some recent trials have shown statistically significant improvements attributable to rehabilitation. For instance, exercise under visual stimulation around a scotoma has been shown to reduce the area of blindness. The improvements occurred only after exercise and never spontaneously. What happens when rehabilitation favours recovery?(ABSTRACT TRUNCATED AT 250 WORDS)