Changes in the clinico-functional characteristics of stroke patients in the acute phase during the COVID-19 pandemic.

OBJECTIVE: To compare the sociodemographic and clinico-functional characteristics of patients admitted to a stroke unit immediately before and during two different COVID-19 pandemic phases. METHODS: This exploratory study was conducted in the stroke unit of a public hospital in Brazil. Patients consecutively admitted to a stroke unit for 18 months with primary stroke aged ≥20 years were included and divided into three groups: G1: Pre-pandemic; G2: Early pandemic; and G3: Late pandemic. The sociodemographic and clinico-functional characteristics of the groups were compared (α=0.05). RESULTS: The study included 383 individuals (G1=124; G2=151; G3=108). The number of risk factors (higher in G2; p≤0.001), smoking (more common in G2; p≤0.01), type of stroke (ischemic more common in G3; p=0.002), stroke severity (more severe in G2; p=0.02), and level of disability (more severe in G2: p≤0.01) were significantly different among the groups. CONCLUSION: A greater number of serious events and risk factors including smoking and higher level of disability was observed in patients in the beginning of the pandemic than in the late phases. Only the occurrence of ischemic stroke increased in the late phase. Therefore, these individuals may have an increased need for rehabilitation services monitoring and care during their lifespan. Additionally, these results indicate that health promotion and prevention services should be strengthened for future health emergencies.

Changes in the clinico-functional characteristics of stroke patients in the acute phase during the COVID-19 pandemic

ABSTRACT Objective To compare the sociodemographic and clinico-functional characteristics of patients admitted to a stroke unit immediately before and during two different COVID-19 pandemic phases. Methods This exploratory study was conducted in the stroke unit of a public hospital in Brazil. Patients consecutively admitted to a stroke unit for 18 months with primary stroke aged ≥20 years were included and divided into three groups: G1: Pre-pandemic; G2: Early pandemic; and G3: Late pandemic. The sociodemographic and clinico-functional characteristics of the groups were compared (α=0.05). Results The study included 383 individuals (G1=124; G2=151; G3=108). The number of risk factors (higher in G2; p≤0.001), smoking (more common in G2; p≤0.01), type of stroke (ischemic more common in G3; p=0.002), stroke severity (more severe in G2; p=0.02), and level of disability (more severe in G2: p≤0.01) were significantly different among the groups. Conclusion A greater number of serious events and risk factors including smoking and higher level of disability was observed in patients in the beginning of the pandemic than in the late phases. Only the occurrence of ischemic stroke increased in the late phase. Therefore, these individuals may have an increased need for rehabilitation services monitoring and care during their lifespan. Additionally, these results indicate that health promotion and prevention services should be strengthened for future health emergencies.

The effects of mental practice based on motor imagery for mobility recovery after subacute stroke: Protocol for a randomized controlled trial.

BACKGROUND AND PURPOSE: Mental practice of motor imagery has shown beneficial effects in stroke recovery. However, there are few clinical trials investigating it on the subacute phase. This study will investigate the effects of mental practice in the mobility of patients with subacute stroke. MATERIALS AND METHODS: Randomized controlled trial including persons with subacute stroke (<3 months). All participants will receive physical exercises and will be randomly allocated into an experimental group (Mental Practice) or into a control group (cognitive training) for 4 weeks(12 sessions). RESULTS: Primary outcomes will be assessed at baseline and after intervention and will be related to mobility, using Timed Up and Go test and 5 m walking speed test. Whereas secondary outcomes will be muscular strength, biomechanical strategies, mental health and quality of life. CONCLUSION: The beneficial effects that may be found in this trial can be greatly relevant in clinical practice, justifying this scientific question.

Motor Imagery Training After Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND AND PURPOSE: A number of studies have suggested that imagery training (motor imagery [MI]) has value for improving motor function in persons with neurologic conditions. We performed a systematic review and meta-analysis to assess the available literature related to efficacy of MI in the recovery of individuals after stroke. METHODS: We searched the following databases: PubMed, Web of Knowledge, Scopus, Cochrane, and PEDro. Two reviewers independently selected clinical trials that investigated the effect of MI on outcomes commonly investigated in studies of stroke recovery. Quality and risk of bias of each study were assessed. RESULTS: Of the 1156 articles found, 32 articles were included. There was a high heterogeneity of protocols among studies. Most studies showed benefits of MI, albeit with a large proportion of low-quality studies. The meta-analysis of all studies, regardless of quality, revealed significant differences on overall analysis for outcomes related to balance, lower limb/gait, and upper limb. However, when only high-quality studies were included, no significant difference was found. On subgroup analyses, MI was associated with balance gains on the Functional Reach Test and improved performance on the Timed Up and Go, gait speed, Action Research Arm Test, and the Fugl-Meyer Upper Limb subscale. DISCUSSION AND CONCLUSIONS: Our review reported a high heterogeneity in methodological quality of the studies and conflicting results. More high-quality studies and greater standardization of interventions are needed to determine the value of MI for persons with stroke.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A188).

Atenção fisioterapêutica no trabalho de parto e parto / Physiotherapy attention on labor and delivery

Introdução: Partos naturais têm sido incentivados pela organização mundial de saúde e o fisioterapeuta, por sua formação, é um profissional que pode auxiliar a parturiente a vivenciar um trabalho de parto menos doloroso e traumático. Objetivo: Observar a visão das parturientes com relação à assistência fisioterapêutica no trabalho de parto e parto. Métodos. O trabalho desenvolveu-se entre os meses de outubro de 2008 e fevereiro de 2009. Após o parto, utilizou-se para coleta das informações um roteiro de entrevista especialmente elaborado para esta finalidade. Cada mulher foi permanentemente acompanhada por uma pesquisadora que ao longo do trabalho de parto empregou diferentes recursos visando, em última análise, o conforto da parturiente. Resultados: Dentre as vinte e uma parturientes, cinco foram assistidas pela fisioterapia. Mulheres jovens, multíparas, com reduzido grau de escolaridade compuseram a amostra estudada. A atuação do fisioterapeuta na assistência obstétrica se fez através de recursos como respiração fisiológica, mobilidade no leito e massoterapia, os quais foram utilizados para reduzir a percepção de dor e contribuir para o conforto e o bem-estar da parturiente. A partir dos relatos das parturientes foi possível observar que a assistência do profissional fisioterapeuta foi bem recebida por elas. Conclusões: A atuação fisioterapêutica durante o trabalho de parto e parto foi importante para diminuição da percepção dolorosa, bem como para o incremento da sensação de segurança e conforto, segundo o olhar das mulheres assistidas.

Introduction: natural births have been encouraged by the World Health Organization and the physical therapist by training, is a professional who can help the mother to experience a labor less painful and traumatic. Objective: To observe the sight of pregnant women regarding physical therapy during labor and delivery. Methods. The work was developed between the months of October 2008 and February 2009. After delivery, was used for data collection a structured interview specifically designed for this purpose. Each woman was continuously monitored by a researcher who over labor resources employed different order, ultimately, the comfort of the mother. Results: Among the twenty-one pregnant women, five were assisted by physiotherapy. Young women, multiparous, with a low educational level comprised the study sample. The role of the physiotherapist in obstetric care was done through resources such as physiological breathing, mobility in bed and massage therapy, which were used to reduce pain perception and contribute to the comfort and well-being of the mother. From the reports of pregnant women was observed that the assistance of the physiotherapist was well received by them. Conclusions: The physical therapy during labor and delivery was important for decreasing pain perception, as well as to increase the sense of security and comfort, through the eyes of the women attended.