Rehabilitation in acute post COVID-19 symptoms with intracranial space occupying lesion: a case report

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2. Older people and those with underlying medical conditions like cardiovascular disease, diabetes, chronic respiratory disease or cancer is more likely to develop serious illness. Acute post COVID-19 patients will get a variety of problems with normal functioning. Rehabilitation could be an effective method for decreasing COVID-19's effects on patient health and function. A 20 years old, female was diagnosed with COVID-19 5 weeks ago, it had been reported shortness of breath, difficult clearing phlegm, headache, nausea and vomiting. The patient had a history of intracranial space occupying lesion (SOL), cerebello pontine angle (CPA) tumor 3 years ago, craniotomy resection of 4th ventricular tumour one year ago and a second craniotomy scheduled for 2021. Several exercises were scheduled for patients including prone position, respiratory muscle training, controlled breathing techniques, bronchial hygiene-airway clearance techniques, aerobic exercise, three times a week, exercises were scheduled. After having completed the exercise program for four weeks, exercise improved shortness of breath, phlegm expenditure, muscle strength, improve lung recoil, vital capacity, range of motion, patient balance and the patient's ability to maximize activity.

Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury

IntroductionDysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI.ObjectiveTo systematically map the accessible research literature to answer the research question: Which non-surgical, non-pharmacological interventions are used in the treatment of dysphagia in patients with moderate and severe ABI in the acute and subacute phase?DesignScoping review based on the methodology of Arksey and O’Malley and methodological advancement by Levac et al.Data sourcesMEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021.Eligibility criteriaAll studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included.Data extraction and synthesisData was extracted by two independent reviewers and studies were categorised based on treatment modality.ResultsA total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into cortical or non-cortical stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training.ConclusionThis scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.

Técnicas respiratórias na melhora da função pulmonar de cardiopatas: Uma Revisão Integrativa

Introduction: Cardiovascular Diseases (CVD) are the main cause of morbidity and mortality in developed and developing countries. According to World Health Organization estimates, 17.9 million people died of CVD in 2016, representing 31% of all global deaths. Material and Method: Integrative review carried out in the databases PubMed, SciELO, Lilacs and PEDro, based on the guiding question of the search: “what is the effect of respiratory techniques on the lung function of patients undergoing cardiac surgery?”, And crossing of the terms: breathing exercises AND preoperative AND cardiac surgery (all terms present in MEsh and DeCs) from May to June 2020. Results: 104 articles were found in the selected databases, 67 articles were excluded, 37 were selected for full reading, eight of which were part of this review. Discussion: The present integrative review aimed to analyze the effects of respiratory techniques on lung function in patients undergoing cardiac surgery. Patients undergoing a cardiac surgical procedure, mainly develop postoperative pulmonary dysfunction with significant reduction in lung volumes, impaired respiratory function, decreased lung compliance and increased respiratory work. Final Considerations: Respiratory techniques such as breathing exercises and / or respiratory muscle training employed in patients undergoing a cardiac surgical procedure, improve lung function, consequently improving respiratory muscle strength as a whole, also interfering in the reduction of post-respiratory complications. CRM in this population.Keywords: Cardiac surgery; Breathing Exercises; Preoperative.

Detraining Effect on Pulmonary and Cardiovascular Autonomic Function and Functional Outcomes in Patients With Parkinson's Disease After Respiratory Muscle Training: An 18-Month Follow-Up Study

Background: The effect of 3-month respiratory muscle training (RMT) on pulmonary and autonomic function and functional outcomes has been demonstrated in patients with Parkinson's disease (PD); however, there is a paucity of information on the durability of the training effect. In this study, we monitored the pulmonary and cardiovascular autonomic function and clinical severity scales until 18 months after the cessation of RMT to elucidate the detraining effect after RMT.Methods: All patients with PD receiving RMT were assessed with clinical severity scales as well as pulmonary and autonomic function tests at four different stages (baseline on enrollment, immediately after 3 months of RMT, and 6 and 18 months after cessation of RMT). A control group of PD patients who did not receive RMT was also recruited for comparison. Pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP), were assessed. Cardiovascular autonomic function was assessed using measures including heart rate response to deep breathing (HRDB), Valsalva ratio, and baroreflex sensitivity. Clinical severity scores were also measured using the Hoehn and Yahr staging and the Unified Parkinson's Disease Rating Scale (UPDRS).Results: The results showed significant improvements in MIP, MEP, HRDB, and UPDRS immediately after RMT. Despite some decay, the improvements in pulmonary function (MIP and MEP) and functional outcomes (UPDRS) remained significant until 6 months of detraining (9 months after enrollment). However, the improvement in cardiovascular autonomic function (HRDB) was reversed after 6 months of detraining.Conclusions: Based on these findings, we recommend that RMT may be repeated after at least 6 months after previous session (9 months after enrollment) for patients with PD to maintain optimal therapeutic effects.

Prehabilitation for Bariatric Surgery: A Randomized, Controlled Trial Protocol and Pilot Study

Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and pilot study of a randomized (ratio 1:1), parallel, controlled trial assessing the effect of a physical conditioning and respiratory muscle training programme, added to a standard 8-week group intervention based on therapeutical education and cognitive-behavioural therapy, in patients awaiting bariatric surgery. The primary outcome is preoperative weight-loss. Secondary outcomes include associated comorbidity, eating behaviour, physical activity, quality of life, and short-term postoperative complications. A pilot sample of 15 participants has been randomized to the intervention or control groups and their baseline features and results are described. Only 5 patients completed the group programme and returned for assessment. Measures to improve adherence will be implemented and once the COVID-19 pandemic allows, the clinical trial will start. This is the first randomized, clinical trial assessing the effect of physical and respiratory prehabilitation, added to standard group education and cognitive-behavioural intervention in obese patients on the waiting list for bariatric surgery. Clinical Trial Registration: NCT0404636.