Stroke: Initial HAS recommendations for rehabilitation in the chronic phase

The High Authority for Health (HAS) publishes its first recommendations for rehabilitation during the chronic phase of cerebrovascular accident (CVA), ie from six months after the accident. The publication extensively reviews all available methods to indicate whether they are recommended or not.

“In France, 150,000 people are affected by a stroke every year and it is the main cause of acquired disabilities in adults”, recalls the HAS. While 500,000 people live with consequential damage, this was long considered irreversible. However, long-term rehabilitation of motor and cognitive functions can improve patients’ quality of life. »highlights the health agency.

These recommendations, intended for the healthcare professionals involved (prescribing physicians and physical therapists, physical therapists, occupational therapists, speech therapists), list the interventions used for motor and cognitive functioning, but do not address drug treatments or therapeutic education.

In the chronic phase, many stroke patients suffer from multiple functional disorders, “such as cognitive, motor or sensory deficiencies, fatigue, psychoaffective disorders, etc. », lists the HAS. Therefore it is important to offer them “adapted rehabilitation follow-up care over time” and complemented by psychological support if necessary.

improve autonomy

“Impairment of motor function after a stroke is very common and has a strong impact on the patient’s daily life and autonomy.”, it is underlined. The recommended methods initially include walking exercises and movement and exercise programs (evidence level A), then biofeedback, orthoses and mirror therapy for the upper extremity (evidence level B).

It is recommended for virtual reality, but combined with other methods for optimal efficiency (level B). May also be suggested, but with a lower level of evidence (Level C), induced upper extremity limitation, motor imagination (in conjunction with another method), postural and balance rehabilitation, or toxin botulinum (in combination with another method).

For example, in robot-assisted rehabilitation or balneotherapy “They cannot be the subject of recommendations at this time due to the lack of available data to scientifically support their usefulness.”appreciates the HAS.

Compensatory measures for cognitive disorders

Cognitive rehabilitation helps the patient and those around them learn to cope with the cognitive impairments caused by the cerebral lesions caused by AVC. “Memory disorders are common and can persist for several years after the accident”, he is reminded. They can increase the patient’s dependency, cause psychological distress and even threaten their safety. Patients may also have difficulty planning and performing two shared tasks, or even attention deficit disorder. Learning how to compensate using internal or external tools (lists, diaries, alarms, human tools, etc.) and acquiring adaptive skills are part of the rehabilitation process.

In addition, the HAS recommends the practice of what is known as “aerobic” physical activity, i.e. not very intense but sustained, in particular with the aim of improving the speed of information processing.


The method of repetitive transcranial magnetic stimulation (rTMS) and therapeutically accompanied computer-aided speech rehabilitation are also recommended for the treatment of communication disorders and in particular aphasia, i.e. the total or partial loss of the ability to communicate. The involvement of the reference person or the partner through information and therapeutic education is indicated. “On the other hand, the current state of science does not allow us to recommend methods such as acupuncture or music therapy”we read.

The HAS points out that the scientific literature on rehabilitation methods after a stroke is available “sometimes limited, even non-existent”. These recommendations can be supplemented and adjusted according to new data.

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