To my knowledge, there are no large, randomized trials supporting the use of neurostimulants in stroke rehabilitation. When patients are too sleepy to participate in therapy, I have been known to use very low-dose methylphenidate or modafinil. Levodopa has also been tried with mixed results.
I only consider a stimulant for patients with arousal issues from mid-brain or thalamic strokes. The data is not robust, but I'll try modafinil to see if there is any improvement.
To address post-stroke fatigue, modafinil has been studied in two small double-blind randomized clinical trials in different settings. One small RCT of 41 patients tested mostly early after stroke within 2 weeks (Poulsen et al., PMID 26534969) and reported safety and improved fatigue scale. Another ...