scholarly journals COVID-19 Pandemic: Clinical Guidance for Aerobic Exercise-Based Stroke Rehabilitation

2021 ◽  
Vol 102 (10) ◽  
pp. e117
Author(s):  
Kevin Moncion ◽  
Lynden Rodrigues ◽  
Marilyn MacKay-Lyons ◽  
Janice Eng ◽  
Sandra Billinger ◽  
...  
Author(s):  
Marilyn MacKay-Lyons ◽  
Sandra A Billinger ◽  
Janice J Eng ◽  
Alex Dromerick ◽  
Nicholas Giacomantonio ◽  
...  

Abstract Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription - the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012-2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.


2017 ◽  
Vol 41 (2) ◽  
pp. 119-128 ◽  
Author(s):  
Pierce Boyne ◽  
Sandra Billinger ◽  
Marilyn MacKay-Lyons ◽  
Brian Barney ◽  
Jane Khoury ◽  
...  

2018 ◽  
Vol 188 (2) ◽  
pp. 469-473
Author(s):  
Hande Gezer ◽  
Ozgur Zeliha Karaahmet ◽  
Eda Gurcay ◽  
Deniz Dulgeroglu ◽  
Aytul Cakci

Author(s):  
Sarah Atwi ◽  
Michelle Sweeny ◽  
Ellen Cohen ◽  
Andrew D Robertson ◽  
Susan Marzolini ◽  
...  

Evidence suggests exercise is ‘good medicine’ post-stroke, yet consensus is lacking on the time to initiate, type, exertion level, and duration per session. It remains a challenge to identify outcome measures for stroke-exercise trials that are sufficiently sensitive to intervention parameters. Cerebrovascular assessments, namely cerebral blood flow and intracranial pulsatility, are herein discussed as examples of quantitative brain-specific measures that may be useful to monitor exercise-related brain changes and help to guide stroke rehabilitation interventions. Bullets: Cerebral blood flow and arterial stiffness are potential vascular targets for stroke exercise trials.


2020 ◽  
Vol 44 (3) ◽  
pp. 179-187
Author(s):  
Kevin Moncion ◽  
Louis Biasin ◽  
David Jagroop ◽  
Mark Bayley ◽  
Cynthia Danells ◽  
...  

2014 ◽  
Vol 21 (sup1) ◽  
pp. S42-S51 ◽  
Author(s):  
Christiane Brown ◽  
Julia E. Fraser ◽  
Elizabeth L. Inness ◽  
Jennifer S. Wong ◽  
Laura E. Middleton ◽  
...  

2020 ◽  
Vol 100 (9) ◽  
pp. 1434-1443
Author(s):  
Elizabeth L Inness ◽  
Anthony Aqui ◽  
Evan Foster ◽  
Julia Fraser ◽  
Cynthia J Danells ◽  
...  

Abstract Objective The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities. Methods This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates. Results The peak heart rate achieved was 65.4% (SD = 10.5%) of the predicted maximum heart rate or 29.1% (SD = 15.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93/195) than because of heart rate limits (60/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of ≥1 mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality. Conclusion A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise. Impact Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke. Lay Summary It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise.


Author(s):  
José G. Centeno

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.


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