Stroke is the second leading cause of death and a major cause of disability worldwide. Its incidence is increasing because the population ages. In addition, more young people are affected by stroke in low- and middle-income countries. Ischemic stroke is more frequent but hemorrhagic stroke is responsible for more deaths and disability-adjusted life-years lost. Incidence and mortality of stroke differ between countries, geographical regions, and ethnic groups. In high-income countries mainly, improvements in prevention, acute treatment, and neurorehabilitation have led to a substantial decrease in the burden of stroke over the past 30 years. This article reviews the epidemiological and clinical data concerning stroke incidence and burden around the globe.

EMIPARESIS REPRESENTS THE dominant functionally limiting symptom in 80% of patients with acute stroke. 1 Within 2 to 5 months after a stroke, patients recover a variable degree of function, depending on the magnitude of the initial deficit. 1 Several studies have demonstrated that recovery is associated with reorganization of central nervous system networks. 2,3 Functional brain imaging of paretic movement during the recovery period has shown recruitment of cortex immediately adjacent to the stroke cavity along with intact cortical areas within the lesioned and in the uninjured contralesional hemisphere. 4,5 The pattern of recruitment depends on the severity of impairment, 6 lesion location, 7 and time since stroke. 8 The factors that initiate and maintain cortical reorganization are not known. Imaging data suggest that circuitry in motor cortices on both sides of the brain is modified during recovery. 2

In February of 2012, the first international conference on real time functional magnetic resonance imaging (rtfMRI) neurofeedback was held at the Swiss Federal Institute of Technology Zurich (ETHZ), Switzerland. This review summarizes progress in the field, introduces current debates, elucidates open questions, and offers viewpoints derived from the conference. The review offers perspectives on study design, scientific and clinical applications, rtfMRI learning mechanisms and future outlook