Early mobilization in acute stroke phase: a systematic review.

BACKGROUND: Early mobilization is defined as out-of-bed activities in acute stroke phase, and has led to improvements in functional capacity and reduction of complications after stroke. OBJECTIVE: This study aimed to investigate the effectiveness and safety of early mobilization in the acute stroke phase. METHODS: This was a systematic review. We searched for studies with the keywords: "Stroke," "Early mobilization" and "Functional outcomes." Data source: NLM, LILACS, MEDLINE, PEDro, and Science Direct. Studies published up to June 2020 were included; (b) study eligibility criteria: clinical trials; (c) participants: stroke patients in the acute phase; (d) interventions: early mobilization; (e) study appraisal: two authors independently assessed the risk of bias, Grading of Recommendations Assessment, Development and Evaluation, and the Oxford Center for Evidence-Based Medicine Levels of Evidence. The safety was evaluated based on related and non-related adverse effects. RESULTS: Altogether, 476 studies were retrieved. After exclusion, seven studies involving 8663 patients were included in the qualitative synthesis. The main activities were elevation of the headboard, sitting, standing, and walking. The most important outcome assessed was the modified Rankin scale score (disability) after 3 months of stroke, and two studies showed that early mobilization improves functional capacity after stroke. CONCLUSION: the optimal time to start early mobilization is > 24 h of stroke according to hemodynamic stability and safety criteria. The duration of mobilization is recommended between 15 and 45 minutes, divided into one, two, or three times a day. The focus of early mobilization should be on sitting, standing, and walking activity.

Adaptation and clinical application of assistive device chair for bedside sitting in acute stroke phase: two case reports.

PURPOSE: This report presents the adaptation of an assistive device chair for bedside sitting and its application in two patients with trunk control impairment in the acute stroke phase. MATERIALS AND METHODS: The device was built with polyvinylchloride (PVC) pipes and designed by a team of mechanical engineers and physiotherapists to maintain a prolonged sitting position with less demand from therapists. To test the device, two patients were followed up during the acute phase of stroke. Both patients underwent an early mobilization program (30 min, twice a day, for three days) with an assistive device chair for bedside sitting. Patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS), Trunk Impairment Scale (TIS), and International Classification of Functioning, Disability, and Health (ICF) checklist (b: body function; d: activity and participation). RESULTS: The adaptations generated the following equipment: 1) foldable, 2) three levels of backrest inclination, and 3) a safety anterior support or an activity table. Both patients showed clinical improvement after the intervention period, with NIHSS score reduction, TIS improvement, and greater functionality and independence on the ICF framework. CONCLUSION: The equipment with adaptations seems to be functional, easy to handle, and can potentially contribute to clinical and functional improvements in patients with trunk control deficits after stroke.

The assistive device chair has a low manufacturing cost, and allow an easy handling and storageThe assistive device chair has been adapted to facilitate sitting posture;The assistive device chair can be used as an auxiliary tool in early mobilizations protocols and contemporary rehabilitation approaches;The early mobilization protocol associated with the assistive device chair can generate clinical improvements in acute stroke.The mobilization protocol associated with the assistive device chair can promote improvement in International Classification of Functioning, Disability, and Health domains in acute stroke.

Changes in Electrical Brain Activity and Cognitive Functions Following Mild to Moderate COVID-19: A one-Year Prospective Study After Acute Infection.

The coronavirus disease 2019 (COVID-19) can disrupt various brain functions. Over a one-year period, we aimed to assess brain activity and cognitive function in 53 COVID-19 patients and 30 individuals without COVID-19 (or asymptomatic). The Montreal Cognitive Assessment, Trail Making Test Parts A and B (TMT-A and B), and Digit Span Test were used to assess cognitive function. Cognitive variables and electroencephalography (EEG) data (activity, mobility, and complexity) were compared between the groups at rest and during cognitive demand (F3-F7, Fz-F3, Fz-F4, and F4-F8). There was a reduction in F3-F7 activity during the TMT-B in the COVID-19 group at 6-12 months compared to the controls (p = 0.01) at baseline (p = 0.03), a reduction in signal complexity at F3-F7 at rest in the COVID-19 group at baseline and 6-12 months compared to the controls (p < 0.001), and a reduction in Fz-F4 activity at rest from 6-12 months in the post-COVID group compared to baseline (p = 0.02) and 3-6 months (p = 0.04). At 6-12 months, there was a time increase in TMT-A in the COVID-19 group compared to that in the controls (p = 0.04). Some correlations were found between EEG data and cognitive test in both groups. In conclusion, there was a reduction in brain activity at rest in the Fz-F4 areas and during high cognitive demands in the F3-F7 areas. A reduction in signal complexity in F3-F7 at rest was found in the COVID-19 group at 6-12 months after acute infection. Furthermore, individuals with COVID-19 experience long-term changes in cognitive function.

Altered Visual and Proprioceptive Spatial Perception in Individuals with Parkinson's Disease.

Difficulties in the integration of visual, vestibular, and somatosensory information in individuals with Parkinson's disease (PD) may alter perception of verticality. Accordingly, in this cross-sectional study, we analyzed PD patients' (n = 13) subjective visual vertical (SVV) and subjective haptic vertical (SHV) perceptions and compared them to those of healthy controls (n = 14). We compared SVV and SHV findings among participants with PD, healthy controls, and cutoff points of normality based on prior research literature, using the parametric nonpaired t test (at p < .05) and Cohen's d (at d > 0.8) to determine clinical relevance. We analyzed SVV with the bucket test and SHV with the rod rotations task in clockwise and counterclockwise directions. We calculated Pearson correlations to analyze the association between verticality tests and the most clinically affected body side. We calculated both the percentage of A-effect (expression of body tilt underestimation to the midline) and E-effect (expression of body tilt overestimation in the upright position). Individuals with PD showed greater variability in right SHV supination compared to the healthy control participants (p = .002). There was greater clinical relevance in right (as opposed to left) SVV (d = 0.83), right (as opposed to left) SHV pronation (d = 0.91), and left (as opposed to right) SHV pronation (d = 0.88). We observed a higher proportion of E-effect in individuals with PD. A significantly higher proportion of patients with PD, compared to patients in past literature, had right SHV pronation (p = .001), left SHV pronation (p = .023), right SHV supination (p = .001), left SHV supination (p = .046), and left SHV pronation (p = .046). Thus, subjective visual and proprioceptive perception of verticality is altered in patients with PD, compared to individuals without PD.