Can the choice reaction time be modified after COVID-19 diagnosis? A prospective cohort study / O tempo de reação de escolha pode ser modificado após o diagnóstico de COVID-19? Um estudo de coorte prospectiva

ABSTRACT Assessment of cognitive processing speed through choice reaction time (CRT) can be an objective tool to assess cognitive functions after COVID-19 infection. Objective: This study aimed to assess CRT in individuals after acute COVID-19 infection over 1 year. Methods: We prospectively analyzed 30 individuals (male: 9, female: 21) with mild-moderate functional status after COVID-19 and 30 individuals (male: 8, female: 22) without COVID-19. Cognitive and neuropsychiatric symptoms were evaluated using the Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS), respectively. CRT (milliseconds) was evaluated by finding the difference between the photodiode signal and the electromyographic (EMG) onset latency of anterior deltoid, brachial biceps, and triceps during the task of reaching a luminous target. CRT was evaluated three times over 1 year after COVID-19: baseline assessment (>4 weeks of COVID-19 diagnosis), between 3 and 6 months, and between 6 and 12 months. Results: The multiple comparison analysis shows CRT reduction of the anterior deltoid in the COVID-19 group at 3-6 (p=0.001) and 6-12 months (p<0.001) compared to the control group. We also observed CRT reduction of the triceps at 6-12 months (p=0.002) and brachial biceps at 0-3 (p<0.001), 3-6 (p<0.001), and 6-12 months (p<0.001) in the COVID-19 compared to the control group. Moderate correlations were observed between MoCA and CRT of the anterior deltoid (r=-0.63; p=0.002) and brachial biceps (r=-0.67; p=0.001) at 6-12 months in the COVID-19 group. Conclusions: There was a reduction in CRT after acute COVID-19 over 1 year. A negative correlation was also observed between MoCA and CRT only from 6 to 12 months after COVID-19 infection.

RESUMO A avaliação da velocidade de processamento cognitivo por meio do tempo de reação de escolha (TRE) pode ser uma ferramenta objetiva para acompanhar as alterações cognitivas após a COVID-19. Objetivo: Avaliar o TRE em pacientes após infecção aguda por COVID-19 ao longo de um ano. Métodos: Foram avaliados 30 indivíduos (sexo masculino: nove; feminino: 21) com estado funcional leve-moderado após infecção por COVID-19 e 30 (sexo masculino: oito; feminino: 22) sem COVID-19. A avaliação foi feita pelo Montreal Cognitive Assessment (MoCA) e pela Escala Hospitalar de Ansiedade e Depressão. O TRE (milissegundos) foi avaliado pela diferença entre o sinal luminoso e a latência de início da atividade muscular (EMG) do deltoide anterior (DA), do bíceps braquial (BB) e do tríceps durante uma tarefa de alcance. O TRE foi avaliado ao longo de um ano: avaliação inicial (>4 semanas após diagnóstico de COVID-19), em 3-6 meses e em 6-12 meses. Resultados: Houve redução do TRE do DA no grupo COVID-19 em 3-6 meses (p=0,001) e 6-12 meses (p<0,001) em comparação com o grupo de controle. Também foi observada redução na TRE do tríceps em 6-12 meses (p=0,002) e do BB em 0-3 meses (p<0,001), 3-6 meses (p<0,001) e 6-12 meses (p<0,001) no grupo COVID-19 em comparação com o grupo de controle. Correlações moderadas foram observadas entre MoCA e TRE do DA (r=-0,63; p=0,002) e BB (r=-0,67; p=0,001) aos 6-12 meses no grupo COVID-19. Conclusões: Houve redução do TRE após COVID-19 ao longo de um ano, além de correlação negativa entre MoCA e TRE no período de seis a 12 meses após COVID-19.

Additional acute effects of virtual reality head-mounted displays on balance outcomes in non-disabled individuals: a proof-of-concept study

Abstract Aim: This study aims to evaluate the additional acute effect of virtual reality (VR) head-mounted displays (HMD) when associated with balance exercises in balance outcomes in non-disabled individuals. Methods: Thirty individuals were randomized into two groups: balance exercise group (GBE; n = 15); and virtual reality + balance exercise group (GVR + BE; n = 15). The individuals were evaluated by static and dynamic balance using the tandem test (TT), single-leg stance (SLS), and Fukuda stepping test (FST). Both groups performed 30 min of balance exercises. The GVR + BE performed 8 additional minutes of virtual reality prior to balance exercises. A roller coaster application was used for the HMD. The Mann-Whitney test was used for intra-group and differences of inter-group analysis, considering a significance level of p < 0.05. Results: In the GBE group analysis, there was observed an increase of time in TT with closed eyes (p = 0.025) and SLS with closed eyes (p = 0.003). In the same way, the GVR + BE group increase TT with closed eyes (p = 0.003) and SLS with closed eyes (p = 0.002) after the intervention. In the intergroup analysis, the increase in the SLS with closed eyes was superior in the GVR + BE group when compared with GBE (p = 0.006; d = 1.67). Conclusion: The use of HMD in combination with balance exercise has an acute effect on increasing static balance in non-disabled individuals.

Single session of action observation in choice reaction time in healthy children

Abstract Aim: Learning by action observation (AO) is a fundamental cognitive ability existing from birth either in live or in the video. However, the specific AO training, in live or in the video, can influence decision making and motor planning in healthy children? This study aimed to evaluate if a single session of both practices (live and video) modifies the choice reaction time during reaching tasks in healthy children. Methods: This is a cross-sectional and randomized study with 22 children aged 6 to 8 years. We measured the choice reaction time (CRT) by electromyography at baseline and after both practices. Data were analyzed using Friedman and posthoc Dunn non-parametric tests for each age group individually as well as all ages combined. Kurtosis analysis was performed to assess data variability. Results: Significant decrease in CRT was observed after action observation in the video in 8-year-olds. Also, we observed choice reaction time variability reduction in 8-year-olds after both practices compared to that at baseline. Conclusion: A decrease in CRT was observed after the single session of action observation in the video in 8-year-olds. Additionally, there was a reduced variability in CRT after performing both practices in the same age group.

Norm scores of cancelation and bisection tests for unilateral spatial neglect: data from a Brazilian population.

OBJECTIVE: Unilateral spatial neglect (USN) results in a consistent and exaggerated spatial asymmetry in the processing of information about the body or space due to an acquired brain injury. There are several USN tests for clinical diagnosis, but none of them are validated in Brazil. The aim was to obtain normative values from a healthy sample in Brazil and to evaluate the effects of demographic variables on USN tests. METHODS: This was a cross-sectional study performed with 150 neurologically healthy individuals. USN was evaluated using the line cancelation (LC), star cancelation (SC), and line bisection (LB) tests in the A3 (29.7 x 42.0 cm) sheet format. RESULTS: In LC, 143 participants had 0 omissions, and the occurrence of failure was significantly associated with aging (OR=1.1[1.02-1.2]; p=0.012). In SC, 145 participants had fewer than 1 omission, and the occurrence of failure was significantly associated with aging (OR=1.07[1.03-1.11]; p<0.001). In LB, deviations were the lowest for those with the highest level of education (r=0.20; p=0.015), and the deviation was 9.5 mm. CONCLUSION: The cutoff points presented in this study may be indicative of USN, but due to performance differences based on age, we suggest using different norm scores for different age groups. These norm scores can be used in the clinic immediately for USN diagnosis.

Norm scores of cancelation and bisection tests for unilateral spatial neglect: data from a Brazilian population

OBJECTIVE: Unilateral spatial neglect (USN) results in a consistent and exaggerated spatial asymmetry in the processing of information about the body or space due to an acquired brain injury. There are several USN tests for clinical diagnosis, but none of them are validated in Brazil. The aim was to obtain normative values from a healthy sample in Brazil and to evaluate the effects of demographic variables on USN tests. METHODS: This was a cross-sectional study performed with 150 neurologically healthy individuals. USN was evaluated using the line cancelation (LC), star cancelation (SC), and line bisection (LB) tests in the A3 (29.7 x 42.0 cm) sheet format. RESULTS: In LC, 143 participants had 0 omissions, and the occurrence of failure was significantly associated with aging (OR=1.1[1.02-1.2]; p=0.012). In SC, 145 participants had fewer than 1 omission, and the occurrence of failure was significantly associated with aging (OR=1.07[1.03-1.11]; p<0.001). In LB, deviations were the lowest for those with the highest level of education (r=0.20; p=0.015), and the deviation was 9.5 mm. CONCLUSION: The cutoff points presented in this study may be indicative of USN, but due to performance differences based on age, we suggest using different norm scores for different age groups. These norm scores can be used in the clinic immediately for USN diagnosis.

Physical therapy in patients with Alzheimer's disease: a systematic review of randomized controlled clinical trials / Fisioterapia em pacientes com doença de Alzheimer: uma revisão sistemática de ensaios clínicos randomizados controlados / Fisioterapia en pacientes con enfermedad de Alzheimer: una revisión sistemática de ensayos clínicos aleatorizados controlados

ABSTRACT The objective of this study is to evaluate the effects of physical therapy on the cognitive and functional capacity of patients with Alzheimer's Disease (AD). This is a systematic review of randomized or quasi-randomized clinical trials, using the descriptors: AD, dementia and physical therapy. Two studies were included with a total of 207 participants. In study 1, no statistically significant difference was found on the mini-mental state examination (MMSE) (MD 0.0, 95%CI −5.76 to 5.76), neuropsychiatric inventory (MD −4.50, 95%CI −21.24 to 12.24) and Pfeffer instrumental activities questionnaire (MD 0.0 95%CI −6.48 to 6.48). In study 2, there was no statistically significant difference on the MMSE (MD −1.60, 95% CI −3.57 to 0.37), clock-drawing test (MD −0.20, 95%CI −0.61 to 0.21) and Alzheimer's Disease Assessment Scale - cognitive subscale (MD 1.0, 95%CI −2.21 to 4.21) after 12 months. There was no consistent evidence on the effectiveness of physiotherapeutic intervention in improving cognitive function and functional capacity of patients with AD. More studies should be conducted for better evidence.

RESUMO O objetivo do estudo é avaliar os efeitos da fisioterapia na capacidade cognitiva e funcional de pacientes com doença de Alzheimer (DA). Trata-se de revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados utilizando os descritores: DA, demência e fisioterapia. Dois estudos foram incluídos, com um total de 207 participantes. No Estudo 1, não houve diferença estatisticamente significativa no miniexame do estado mental (MEEM) (MD 0,0, IC 95% 5,76−5,76), inventário neuropsiquiátrico (MD −4,50, IC 95% 12,24−21,24) e questionário de atividades instrumentais Pfeffer (MD 0,0 IC 95% −6,48 a 6,48). No Estudo 2, não houve diferença estatisticamente significativa no MEEM (MD −1,60, IC 95% −3,57 a 0,37), teste do desenho do relógio (MD −0,20, IC95% −0,61 a 0,21) e escala de avaliação da doença de Alzheimer - subitem cognição (MD 1,0, IC95% −2,21 a 4,21) após 12 meses. Não houve evidência consistente da eficácia da intervenção fisioterapêutica na melhora da função cognitiva e capacidade funcional na DA. Recomenda-se a produção de mais estudos para encontrar possíveis evidências.

RESUMEN El presente estudio tiene como objetivo evaluar los efectos de la fisioterapia en la capacidad cognitiva y funcional de pacientes con enfermedad de Alzheimer (EA). Se trata de una revisión sistemática de ensayos clínicos aleatorizados o casi-aleatorizados, en que se utilizó los descriptores: EA, demencia y fisioterapia. Se incluyeron dos estudios, con un total de 207 participantes. En el Estudio 1, no hubo diferencias estadísticamente significativas en el Miniexamen del estado mental (MEEM) (MD 0,0, IC 95%: 5,6 -5,76), en el inventario neuropsiquiátrico (MD -4,50, IC 95%: 12,24 -21,24) y en el cuestionario de actividades instrumentales de Pfeffer (MD: 0,0 IC 95% IC: -6,48 a 6,48). En el Estudio 2, no hubo diferencias estadísticamente significativas en el MEEM (MD −1,60, IC 95% −3,57 a 0,37), el test de diseño del reloj (MD −0,20, IC 95% −0,61 a 0,21) y la escala de evaluación de la enfermedad de Alzheimer: subítem de cognición (MD 1,0, IC 95% −2,21 a 4,21) tras 12 meses. No hubo evidencia consistente de la eficacia de la intervención fisioterapéutica en la mejora de la función cognitiva y de la capacidad funcional en la EA. Se recomienda realizar estudios adicionales para encontrar posibles evidencias.

Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity.

OBJECTIVE: The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS: This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors. RESULTS: We studied 60 patients with a median age of 68 (34-89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03-1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13-2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78-0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48-0.92], p=0.017). CONCLUSION: The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.

Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity

OBJECTIVE: The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS: This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors. RESULTS: We studied 60 patients with a median age of 68 (34-89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03-1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13-2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78-0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48-0.92], p=0.017). CONCLUSION: The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.