The current status of stroke rehabilitation in Japan was reviewed from the perspectives of epidemiology, structures, outcomes and research. Japan is the fastest aging society in the world, facing a rapid increase in its disabled population and ensuing healthcare costs. Although its mortality is decreasing, stroke is the most frequent cause of disability. Traditionally, stroke patients acutely admitted to general hospitals remained bed-ridden for months, hindering maximal functional gain. With more attention to the importance of rehabilitation, improved outcomes such as shorter length of stay, more functional gain and increased community discharge have resulted. Japan's healthcare system, characterized by universal coverage, equity and a mandatory fee schedule, has contributed to the world's longest life expectancy and the lowest infant mortality rate, but it has also lacked quality assurance. Under stringent economic conditions, drastic healthcare and welfare reform plans are being debated and pressure is mounting for more efficient stroke rehabilitation.