Comparison of Two Rehabilitation Strategies in Patients With Hemiparesis One Year or More After Stroke

In the situation of motor limitations that people often experience after stroke, current health systems cannot provide for the daily amount and duration of high intensity muscle stretch and motor training that would be required over protracted periods to involve muscle and brain plasticity. For patients with sufficient cognitive abilities, Guided Self-rehabilitation Contracts allow implementing stretch and training at high intensity and may result in meaningful functional improvement in chronic stages, as long as discipline persists over at least a year span.

This single blind control protocol will evaluate Guided Self-rehabilitation Contracts as against conventional therapy in the community, for a one year duration in persons with chronic hemiparesis after stroke.

This single blind controlled multicentre protocol will compare the evolution after a one-year treatment, either using a Guided Self-rehabilitation Contract or conventional therapy in the community. Patients with chronic stroke-induced hemiparesis (over a year post stroke) will be selected to be randomized between the two groups, Conventional or in Guided Self-rehabilitation Contracts.

In Guided Self-rehabilitation Contracts, the therapist acts as a coach, in the sports' sense, providing double guidance:

* Technical, selecting and teaching the required exercises to the patient using infrequent thorough visits, for example every month.
* Psychological, binding with the patient on the contract.

The patient agrees to:

* Perform the prescribed daily stretch postures and rapid alternating movements over the long term.
* Document this work in a written diary.

To facilitate such contracts, a manual for guided self-rehabilitation in spastic paresis has been developed and will be provided to patients randomized to that group.

124 patients will be enrolled from 6 centers in France: Creteil, Paris Fernand-Widal, Toulouse, Reims, Saint-Etienne and Bordeaux. The duration of patient participation will be 2 years: 6 months follow-up, 1 year intervention and another 6-month follow-up after the study intervention. Only functional assessments will be used, using in particular ambulation speed for the lower limb and the Modified FRENCHAY Scale for the upper limb.

Eligibility Criteria:
Inclusion Criteria:

* Patient with spastic hemiparesis, following a unique stroke episode over a year before enrollment into the study
* Age ≥ 18
* Barefoot walking possible with no assistive device over 10 m
* Fast barefoot ambulation speed between 0.1 m/sec and 1.3 m/sec
* Mean Modified FRENCHAY Score between 2 and 8/10
* Patient having provided a signed consent to participate in this trial

Exclusion Criteria:

* Multiple stroke episodes, clinically of based on brain imaging
* No recent (less than 3 months before enrollment) brain imaging (CT scan or MRI) in case of doubt about multiple stroke episodes
* Concurrent severe condition jeopardizing functional or vital prognosis, or the ability to participate in rehabilitation sessions
* Cognitive, phasic or behavioral condition impeding verbal communication, active participation to a rehabilitation or self-rehabilitation program, or participation in a research study, according to the investigator's judgment
* Person having a tutor or benefiting from a law protection order
* Person not benefiting from French State Health Insurance