Ischemic Stroke in a 29-Year-Old Patient with COVID-19: A Case Report

Increasing evidence reports a greater incidence of stroke among patients with Coronavirus disease 2019 (COVID-19) than the non-COVID-19 population and suggests that SARS-CoV-2 infection represents a risk factor for thromboembolic and acute ischemic stroke. Elderly people have higher risk factors associated with acute ischemic stroke or embolization vascular events, and advanced age is strongly associated with severe COVID-19 and death. We reported, instead, a case of an ischemic stroke in a young woman during her hospitalization for COVID-19-related pneumonia. A 29-year-old woman presented to the emergency department of our institution with progressive respiratory distress associated with a 2-day history of fever, nausea, and vomiting. The patient was transferred to the intensive care unit (ICU) where she underwent a tracheostomy for mechanical ventilation due to her severe clinical condition and her very low arterial partial pressure of oxygen. The nasopharyngeal swab test confirmed SARS-CoV-2 infection. Laboratory tests showed neutrophilic leucocytosis, a prolonged prothrombin time, and elevated D-dimer and fibrinogen levels. After 18 days, during her stay in the ICU after suspension of the medications used for sedation, left hemiplegia was reported. Central facial palsy on the left side, dysarthria, and facial drop were present, with complete paralysis of the ipsilateral upper and lower limbs. Computed tomography (CT) of the head and magnetic resonance imaging of the brain confirmed the presence of lesions in the right hemisphere affecting the territories of the anterior and middle cerebral arteries, consistent with ischemic stroke. Pulmonary and splenic infarcts were also found after CT of the chest. The age of the patient and the absence of serious concomitant cardiovascular diseases place the emphasis on the capacity of SARS-CoV-2 infection to be an independent cerebrovascular risk factor. Increased levels of D-dimer and positivity to β2-glycoprotein antibodies could confirm the theory of endothelial activation and hypercoagulability, but other mechanisms – still under discussion – should not be excluded

Effectiveness of robotic balance training on postural instability in patients with mild Parkinson's disease: A pilot, single blind, randomized controlled trial

OBJECTIVE: To examine whether tailored robotic platform training could improve postural stability compared with conventional balance treatment in patients with mild Parkinson's disease. Design: Randomized single-blind pilot study.SUBJECTS: Twenty-two patients with mild Parkinson's disease (Hoehn and Yahr scale; HandY 1-2).METHODS: Patients were randomly assigned to an experimental group for robotic balance training and to a control group for conventional balance training. Each patient received 20 treatments (45 min/session, 5 times/week). Blinded evaluations were conducted before and after the treatment and 1 month post-treatment. Primary outcome measures were Mini BESTest, and Berg Balance Scale; secondary outcome measures were 10-Meter Walk Test, Five Times Sit to Stand Test, and Parkinson's Disease Questionnaire 39.RESULTS: Primary outcome measures in patients in both the experimental and control groups improved significantly after the balance treatment. Similar results were found for all the secondary outcome measures. The experimental group performed significantly better than the control group at both post-intervention and follow-up evaluation in the primary outcomes (p<0.05). No significant differences be-tween groups were found in secondary outcomes.CONCLUSION: Robot-assisted balance training may be a promising tool to improve postural stability in patients with mild Parkinson's disease

L’ESERCIZIO CON DINAMOMETRO ISOCINETICO NELLA FASE RIABILITATIVA DELLE LESIONI MUSCOLARI. Abstract n.199 MAIN TOPIC 1: b. Dal PDTA alla presa in carico della persona con disabilità MUSCOLO-SCHELETRICA.

La lesione muscolare si verifica quando la forza applicata su un muscolo provoca danni strutturali al suo tessuto. La posizione, la gravità e il tipo di lesione dipendono dal meccanismo con cui viene applicata la forza, dalla condizione del tessuto prima della lesione e dallo stato di attivazione del muscolo durante la lesione. La fase riabilitativa ricopre un ruolo fondamentale nel ritorno alle normali attività e nella prevenzione di una recidiva. L’esercizio contro resistenza, in particolare quello eccentrico, favorisce il moltiplicarsi delle cellule satellite influenzando positivamente il processo di guarigione. Il dinamometro isocinetico potrebbe rappresentare un valido strumento di valutazione funzionale e di trattamento riabilitativo. Materiali e metodi Presso la SC di Medicina Fisica e Riabilitativa Universitaria degli Ospedali Riuniti di Foggia sono stati reclutati pazienti con lesioni muscolari diagnosticate mediante Risonanza Magnetica. Di questi sono stati arruolati 4 pazienti (età media 44 anni) con una lesione muscolare agli ischiocrurali da grado II a grado IV, almeno 15 giorni dopo l’evento, in grado di mantenere una contrazione isometrica massimale e con deambulazione nei limiti della norma. Sono stati sottoposti ad una valutazione con dinamometro isocinetico per la flesso-estensione del ginocchio con 5 ripetizioni a 180°/s e 60°/s al T0 (inizio trattamento) e al T1(fine trattamento). Sono state effettuate 10 sedute, 3 volte a settimana con dinamometro isocinetico effettuando esercizi isocinetici (concentrici ed eccentrici) e isometriche dei muscoli flessori ed estensori del ginocchio, a intensità submassimale e velocità angolare crescente (da 60°/s). Il dolore è stato valutato mediante NRS riferito alle 24h precedenti. Risultati I pazienti sottoposti a tale trattamento hanno evidenziato una riduzione del deficit nei flessori di ginocchio da 45 +/- 15% al T0 a 25 +/- 8% al T1. È stato anche ottenuto un incremento del picco di coppia di forza del lato leso di 22 +/- 5 N/m. La scala NRS ha evidenziato una riduzione da 5 +/- 2 a T0 a 3 +/- 2 a T1. Conclusioni Nella fase di recupero funzionale (15-60 giorni dopo l’evento), l’obiettivo riabilitativo delle lesioni muscolari è ripristinare il completo recupero della forza e della funzione muscolare. Il dinamometro isocinetico si è dimostrato uno strumento estremamente sicuro ed efficace in questa fase sia a scopo valutativo che terapeutico

Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review

During the last decades, many studies have been carried out to understand the possible positive effects of vibration therapy in post-stroke rehabilitation. In particular, the use of localized muscle vibration (LMV) seems to have promising results. The aim of this systematic review was to describe the use of LMV in post-stroke patients to improve motor recovery, reducing spasticity and disability in both upper and lower limb

Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity

BACKGROUND: The COVID-19 pandemic has affected health-care systems worldwide, including the outpatient spasticity care with botulinum neurotoxin toxin type A (BoNT-A). AIM: The aim was to investigate the impact of discontinuation of BoNT-A treatment on patients living with spasticity during the COVID-19 quarantine. DESIGN: A multicentric cross-sectional study. SETTING: Outpatients setting. POPULATION: Patients with spasticity after stroke and traumatic brain injury treated with BoNT-A. METHODS: A phone-based survey was conducted from March to May, 2020. Based on the International Classification of Functioning, Disability and Health (ICF), an ad hoc questionnaire CORTOX (CORonavirus TOXin survey) was developed to investigate patients\u2019 experiences following the discontinuation of their usual treatment for spasticity due to the lockdown and its implication on their health perception. It assessed patients\u2019 condition and explored different ICF domains related to spasticity: unpleasant sensations, mobility, self care, facilitators and psychosocial factors. The sum of those represented the CORTOX score (Max 142). The questionnaire also collected data about the impact of COVID-19 on patients\u2019 wellbeing (mood, sleep, relationships, community life, motivation). RESULTS: A total of 151 participants completed the survey. The majority of participants (72.2 %) experienced a worsening in perceived spasticity, 53% got worse in independence and 70.9% had a negative impact on quality of life. The mean CORTOX score was 52.85 \ub1 27.25, reflecting a perceived worsening in all ICF domains investigated. Moderate to strong correlations were found between different subscores of the questionnaire and severity of spasticity (p<0.001). COVID-19 psychosocial related factors were associated with loss of independence (p < 0.05) but only mood was associated with worsening of spasticity (p < 0.001). The lack of rehabilitation therapy was significantly associated with the worsening of independence but not with the worsening of spasticity. Finally, respondents reported that BoNT-A was useful to their condition and should not be discontinued. CONCLUSIONS: The discontinuation of BoNT-A treatment was associated with worsening of activities and participation and perceived spasticity. COVID-19 related problems and rehabilitation showed an association with loss of independence. CLINICAL REHABILITATION IMPACT: This study will provide useful information in the field of spasticity management using a patient\u2019s centred approach, with consistent quantitative and qualitative information