earlY Upper Limb Rehabilitation WIth EEG-Neurofeedback After Stroke

• electroencephalographic neurofeedback (Other): The patient is installed in a quiet, isolated room in the Physical Medicine and Rehabilitation Department. The patient sits comfortably in front of a computer. A nurse or a rehabilitator installs the EEG headset and places gel in the electrodes (x32). Connecting the amplifier and interface. Checking the correct positioning and contact of the electrodes (impedance). * Calibration phase at rest. * Working phase: the sessions last 24 minutes. The patient will be asked to concentrate on the affected arm, and to imagine a movement of this arm, to feel the sensations, without any real movement of the arm. * In the Neurofeedback group, the patient will receive visual feedback of a virtual hand moving on a computer screen in front of him/her, depending on his/her brain activations. He will also receive haptic feedback (vibrations) in the flexor muscles of his wrist.
• SHAM electroencephalographic neurofeedback (Other): The patient is installed in a quiet, isolated room in the Physical Medicine and Rehabilitation Department. The patient sits comfortably in front of a computer. A nurse or a rehabilitator installs the EEG headset and places gel in the electrodes (x32). Connecting the amplifier and interface. Checking the correct positioning and contact of the electrodes (impedance). * Calibration phase at rest. * Working phase: the sessions last 24 minutes. The patient will be asked to concentrate on the affected arm, and to imagine a movement of this arm, to feel the sensations, without any real movement of the arm. * In the SHAM group, the visual feedback and haptic feedback are randomly generated

Primary outcomes

• Measurement of motor impairment by the Fugl-Meyer Assesment - Upper Extremity [28 days]: Measurement of motor impairment by the Fugl-Meyer Assesment - Upper Extremity

Secondary outcomes

• Changes in ACTIVE RANGE OF MOTION (CxA) composite score [28 days]: Changes in ACTIVE RANGE OF MOTION (CxA) composite score
• Changes in ACTIVE RANGE OF MOTION (CxA) composite score [3 months]: Changes in ACTIVE RANGE OF MOTION (CxA) composite score
• Changes in Action Research Arm Test (ARAT) score [28 days]: Changes in Action Research Arm Test (ARAT) score
• Changes in Action Research Arm Test (ARAT) score [3 months]: Changes in Action Research Arm Test (ARAT) score
• Changes in force emitted (in kg) during a palmar grip (JAMAR) [28 days]: Changes force emitted (in kg) during a palmar grip (JAMAR)
• Changes in force emitted (in kg) during a palmar grip (JAMAR) [3 months]: Changes force emitted (in kg) during a palmar grip (JAMAR)
• Progression in Evaluation of the Motor activiy Log (MAL) [28 days]: Progression in Evaluation of the Motor activiy Log (MAL)
• Progression in Evaluation of the Motor activiy Log (MAL) [3 months]: Progression in Evaluation of the Motor activiy Log (MAL)
• Progression in The Composite Functional Independence Scale (MIF) [28 days]: Progression in The Composite Functional Independence Scale (MIF)
• Progression in The Composite Functional Independence Scale (MIF) [3 months]: Progression in The Composite Functional Independence Scale (MIF)
• Progression in The Stroke Impact Scale (SIS) [28 days]: Progression in The Stroke Impact Scale (SIS)
• Progression in The Stroke Impact Scale (SIS) [3 months]: Progression in The Stroke Impact Scale (SIS)
• Brain activity measured by electroencephalogram : improvement in cerebral activations in target zones [28 days]: Brain activity measured by electroencephalogram : improvement in cerebral activations in target zones
• Brain datas (fMRI activity and CST tractography) [28 days]: Brain datas (fMRI activity and CST tractography)
• Acceptability of overseeing the neurofeedback protocol among healthcare professionals (semi-open interviews) [3 months]: Assessing the a priori acceptance (acceptability) of overseeing neurofeedback protocol among healthcare professionals involved in the care of post-stroke patients, measured by semi-open interviews
• Acceptability of overseeing the neurofeedback protocol among healthcare professionals (questionnaires) [3 months]: Assessing the a priori acceptance (acceptability) of overseeing the neurofeedback protocol among healthcare professionals involved in the care of post-stroke patients, measured by questionnaires.
• Acceptance of overseeing the neurofeedback protocol among healthcare professionals (semi-open interviews) [3 months]: Assessing the retrospective adoption (acceptance) of overseeing the neurofeedback protocol among healthcare professionals involved in the care of post-stroke patients, measured by semi-open interviews
• Acceptance of overseeing the neurofeedback protocol among healthcare professionals (questionnaires) [3 months]: Assessing the retrospective adoption (acceptance) of overseeing the neurofeedback protocol among healthcare professionals involved in the care of post-stroke patients, measured by questionnaires.

Sex: All, ages: 18 Years to 80 Years

Inclusion Criteria:

* Unilateral ischaemic or haemorrhagic stroke
* Adult (18-80 years), both sexes
* Stroke < 3 weeks
* Upper limb deficit defined by Shoulder Abduction Finger Extension score <5 measured during the 7 days following stroke; i.e., patients predicted to have incomplete recovery
* No participation-limiting comprehension problems
* With or without homonymous lateral hemianopia; with or without visuospatial hemineglect
* Free, informed and written consent signed by the patient or a member of the patient's family (in the case of a patient who is able to understand the information and give consent but has motor difficulties resulting in an invalid signature).
* Affiliated to french social security

Exclusion Criteria:

* Ischemic or hemorrhagic brain stem and/or cerebellum involvement
* Multiple strokes
* Stroke < 1 week; in order not to be deleterious by starting active rehabilitation too early after immediate stroke
* Aphasia with major comprehension impairment
* Contraindication to MRI

  * pacemaker or implantable defibrillator,
  * neurosurgical clips,
  * cochlear implants,
  * intra-orbital or encephalic metallic foreign bodies,
  * stents placed less than 4 weeks ago and osteosynthesis devices placed less than 6 weeks ago,
  * claustrophobia. (Patients who have undergone thrombolysis or thrombectomy may be included in the study.)

• Simon BUTET, MD, Principal investigator, Rennes CHU