Deans' stroke musings: Very Early Versus Delayed Mobilization After Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 17, 2019

Very Early Versus Delayed Mobilization After Stroke

My God, have you got the understanding of what is occurring wrong. The neuronal cascade of death

is still occurring during this early rehab. And you didn't know about that or measure its occurrence?

I don't care how influential Julie Bernhardt is in stroke circles, she's wrong here, missing what is occurring during the neuronal cascade of death.

Very Early Versus Delayed Mobilization After Stroke

Originally published16 May 2019https://doi.org/10.1161/STROKEAHA.119.024502Stroke. 2019;50:e178–e179

Objective

The objective of this review is to determine whether very early mobilization (helping a patient get out of bed within 48 hours after stroke onset) improves or harms recovery after stroke.¹

Methods

We systematically searched the Cochrane Stroke Group trials register, 19 English language electronic databases, Wanfang data (Chinese language medical database), relevant ongoing trials and research registers, reference lists, and contacted researchers in the field.
We selected unconfounded randomized controlled trials and compared mobilization commencing within 48 hours with usual stroke care.
One author eliminated obviously irrelevant records; 2 authors independently selected English language trials, extracted data, assessed risk of bias, and applied the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach to the quality of evidence.

Main Results

Seventy-four full papers were assessed. Nine trials were included (n=2958). Participants were median age 68 years; 52% were males; 0% to 20% had intracerebral hemorrhage; and stroke severity was typically moderate. Very early mobilization participants started mobilization median 18.5 hours (interquartile range, 13.1−43 hours) after stroke compared with 33.3 hours (interquartile range, 22.5−71.5 hours) in usual care. Very early mobilization did not increase the number of people who survived or made a good recovery after their stroke (odds ratio, 1.08; 95% CI, 0.92−1.26; Figure).

**Figure.** Death or poor outcome at end of scheduled follow-up. M-H indicates Mantel-Haenszel test; and VEM, very early mobilization.

Conclusions

Commencing mobilization earlier after stroke did not improve death or poor outcome. Possible risks within 24 hours need clarifying. Further research to determine the optimal dose and timing of mobilization after acute stroke is needed.