Differences in muscle thickness and echo intensity between stroke survivors and age- and sex-matched healthy older adults

Objective: The stroke survivors exhibit change in muscle quantity and quality compared to healthy older adults. This study aimed to compare the muscle thickness (MT) and echo intensity (EI) values of individual muscles between stroke survivors and age- and sex-matched healthy older adults. Methods : In total, 27 stroke survivors and 34 healthy older adults participated in this study. The MT and EI values of the following muscles were assessed from transverse ultrasound images: rectus abdominis (RA), external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius (VI), vastus lateralis (VL), vastus medialis (VM), tibialis anterior (TA), gastrocnemius (Gas), and soleus (Sol). The MT and EI values of these muscles were compared between stroke survivors and healthy older adults. Results : The MT values of the VL, VM, and RA on the non-paretic sides were significantly higher and those of the TA, Gas, and Sol on the paretic sides were significantly lower in the stroke survivors than in the healthy older adults (P < 0.05). The EI values of the VI, VL, VM, TA on the paretic sides and those of the Gas on both the paretic and non-paretic sides were significantly higher in the stroke survivors than in the healthy older adults (P < 0.05). Conclusion : Stroke survivors seem to develop muscle hypertrophy of the non-paretic thigh muscles owing to a compensatory strategy. In addition, the lower-leg muscles on the paretic side of stroke survivors tend to show both quantitative and qualitative muscle changes.     

Changes in cerebral activity after decreased upper-limb hypertonus: an EMG-fMRI study

Objective

Whereas several studies have used functional magnetic resonance imaging (fMRI) to investigate motor recovery, whether therapy to decrease post-stroke hypertonus alters central motor patterns remains unclear. In this study, we used continuous electromyography (EMG)-fMRI to investigate possible changes in movement-related brain activation in patients receiving Botulinum toxin (BoNT-A) for hand-muscle hypertonus after chronic stroke.

Methods

We studied eight stroke patients all of whom had hemiparesis and associated upper-limb hypertonus. All patients underwent an fMRI-EMG recording and clinical-neurological assessment before BoNT-A and 5 weeks thereafter. The handgrip motor task during imaging was fixed across both patients and controls. The movements were metronome paced, movement amplitude and force were controlled with a plastic orthosis, dynamometer and EMG recording. An age-matched control group was recruited from among healthy volunteers underwent the same fMRI-EMG recording.

Results

Before BoNT-A, while patients moved the paretic hand, fMRI detected wide bilateral activation in the sensorymotor areas (SM1), in the supplementary motor area (SMA) and cerebellum. After BoNT-A blood oxygenation level-dependent (BOLD) activation decreased in ipsilateral and contralateral motor areas and became more lateralized. BOLD activation decreased also in ipsilateral cerebellar regions and in the SMA.

Conclusion

Changes in peripheral upper-limb hypertonus after BoNT-A were associated to an improvement in active movements and more lateralized and focalized activation of motor areas. The clinical and EMG-fMRI coregistration technique we used to study hand-muscle hypertonus in patients receiving BoNT-A after chronic stroke should be useful in future studies seeking improved strategies for post-stroke neurorehabilitation.     

Correlating magnetic resonance imaging markers of axonal injury and demyelination in motor impairment secondary to stroke and multiple sclerosis

The primary pathological mechanisms in stroke and multiple sclerosis (MS) are very different but in both diseases, impairment may arise from a final common pathway of axonal damage. We aimed to examine the relationship between motor impairment, magnetisation transfer ratio (MTR) (an index of demyelination), and N-acetyl aspartate (NAA) loss (an index of axonal injury) localised to the descending motor pathways in stroke and MS. Twelve patients between 1 and 10 months after first ischaemic stroke causing a motor deficit and 12 patients with stable MS with asymmetric motor deficit were examined. T(2)-weighted imaging of the brain together with MTR and proton (voxel 1.5x2x2 cm(3)) MRS localised to the posterior limb of the internal capsule were performed and correlated to a composite motor deficit score. MTR and NAA in the internal capsule were reduced in both stroke and MS patients compared to controls. NAA loss correlated with motor deficit score in both stroke and MS (p<0.001 and p = 0.04, respectively). Correlations were seen between MTR and motor deficit (p<0.001) MTR and NAA loss (p <0.001) in stroke patients but not in MS patients. Axonal injury in the descending motor tracts would appear to be an important determinant of motor impairment in both stroke and MS. In stroke, MTR measures of demyelination are closely related to axonal damage and thus also correlate with motor deficit. However in MS, MTR measures of demyelination do not correlate with NAA loss or motor deficit suggesting that demyelination and gliosis may occur independently of axonal damage and are less closely linked with functional impairment.     

A Narrative Review of Alternate Gait Training Using Knee-ankle-foot Orthosis in Stroke Patients with Severe Hemiparesis

Impairments resulting from stroke lead to persistent difficulties with walking. Subsequently, an improved walking ability is one of the highest priorities for people living with stroke. The degree to which gait can be restored after a stroke is related to both the initial impairment in walking ability and the severity of paresis of the lower extremities. However, there are some patients with severe motor paralysis and a markedly disrupted corticospinal tract who regain their gait function. Recently, several case reports have described the recovery of gait function in stroke patients with severe hemiplegia by providing alternate gait training. Multiple studies have demonstrated that gait training can induce “locomotor-like” coordinated muscle activity of paralyzed lower limbs in people with spinal cord injury. In the present review, we discuss the neural mechanisms of gait, and then we review case reports on the restoration of gait function in stroke patients with severe hemiplegia.     

Non-receptor tyrosine kinase Src is required for ischemia-stimulated neuronal cell proliferation via Raf/ERK/CREB activation in the dentate gyrus

Background  

Neurogenesis in the adult mammalian hippocampus may contribute to repairing the brain after injury. However, Molecular mechanisms that regulate neuronal cell proliferation in the dentate gyrus (DG) following ischemic stroke insult are poorly understood. This study was designed to investigate the potential regulatory capacity of non-receptor tyrosine kinase Src on ischemia-stimulated cell proliferation in the adult DG and its underlying mechanism.     

Contribution of primary motor cortex to compensatory balance reactions

ABSTRACT: BACKGROUND: Rapid compensatory arm reactions represent important response strategies following an unexpected loss of balance. While it has been assumed that early corrective actions arise largely from sub-cortical networks, recent findings have prompted speculation about the potential role of cortical involvement. To test the idea that cortical motor regions are involved in early compensatory arm reactions, we used continuous theta burst stimulation (cTBS) to temporarily suppress the hand area of primary motor cortex (M1) in participants prior to evoking upper limb balance reactions in response to whole body perturbation. We hypothesized that following cTBS to the M1 hand area evoked EMG responses in the stimulated hand would be diminished. To isolate balance reactions to the upper limb participants were seated in an elevated tilt-chair while holding a stable handle with both hands. The chair was held vertical by a magnet and was triggered to fall backward unpredictably. To regain balance, participants used the handle to restore upright stability as quickly as possible with both hands. Muscle activity was recorded from proximal and distal muscles of both upper limbs. RESULTS: Our results revealed an impact of cTBS on the amplitude of the EMG responses in the stimulated hand muscles often manifest as inhibition in the stimulated hand. The change in EMG amplitude was specific to the target hand muscles and occasionally their homologous pairs on the non-stimulated hand with no consistent effects on the remaining more proximal arm muscles. CONCLUSIONS: Present findings offer support for cortical contributions to the control of early compensatory arm reactions following whole-body perturbation.     

Nodal discontinuous Galerkin methods on graphics processors

Discontinuous Galerkin (DG) methods for the numerical solution of partial differential equations have enjoyed considerable success because they are both flexible and robust: They allow arbitrary unstructured geometries and easy control of accuracy without compromising simulation stability. Lately, another property of DG has been growing in importance: The majority of a DG operator is applied in an element-local way, with weak penalty-based element-to-element coupling.     

Continuous and discontinuous Galerkin methods for a scalable three-dimensional nonhydrostatic atmospheric model: Limited-area mode

This paper describes a unified, element based Galerkin (EBG) framework for a three-dimensional, nonhydrostatic model for the atmosphere. In general, EBG methods possess high-order accuracy, geometric flexibility, excellent dispersion properties and good scalability. Our nonhydrostatic model, based on the compressible Euler equations, is appropriate for both limited-area and global atmospheric simulations. Both a continuous Galerkin (CG), or spectral element, and discontinuous Galerkin (DG) model are considered using hexahedral elements. The formulation is suitable for both global and limited-area atmospheric modeling, although we restrict our attention to 3D limited-area phenomena in this study; global atmospheric simulations will be presented in a follow-up paper. Domain decomposition and communication algorithms used by both our CG and DG models are presented. The communication volume and exchange algorithms for CG and DG are compared and contrasted. Numerical verification of the model was performed using two test cases: flow past a 3D mountain and buoyant convection of a bubble in a neutral atmosphere; these tests indicate that both CG and DG can simulate the necessary physics of dry atmospheric dynamics. Scalability of both methods is shown up to 8192 CPU cores, with near ideal scaling for DG up to 32,768 cores.     

Both projection and commissural pathways are disrupted in individuals with chronic stroke: investigating microstructural white matter correlates of motor recovery

ABSTRACT: BACKGROUND: Complete recovery of motor function after stroke is rare with deficits persisting into the chronic phase of recovery. Diffusion tensor imaging (DTI) can evaluate relationships between white matter microstructure and motor function after stroke. The objective of this investigation was to characterize microstructural fiber integrity of motor and sensory regions of the corpus callosum (CC) and descending motor outputs of the posterior limb of the internal capsule (PLIC) in individuals with chronic stroke and evaluate the relationships between white matter integrity and motor function. RESULTS: Standardized measures of upper extremity motor function were measured in thirteen individuals with chronic stroke. Manual dexterity was assessed in thirteen healthy age-matched control participants. DTI scans were completed for each participant. Fractional anisotropy (FA) of a cross-section of sensory and motor regions of the CC and the PLIC bilaterally were quantified. Multivariate analysis of variance evaluated differences between stroke and healthy groups. Correlational analyses were conducted for measures of motor function and FA. The stroke group exhibited reduced FA in the sensory (p = 0.001) region of the CC, contra- (p = 0.032) and ipsilesional (p = 0.001) PLIC, but not the motor region of the CC (p = 0.236). In the stroke group, significant correlations between contralesional PLIC FA and level of physical impairment (p = 0.005), grip strength (p = 0.006) and hand dexterity (p = 0.036) were observed. CONCLUSIONS: Microstructural status of the sensory region of the CC is reduced in chronic stroke. Future work is needed to explore relationships between callosal sensorimotor fiber integrity and interhemispheric interactions post-stroke. In addition, contralesional primary motor output tract integrity is uniquely and closely associated with multiple dimensions of motor recovery in the chronic phase of stroke suggesting it may be an important biomarker of overall motor recovery.     

Optimized 3D bright blood MRI of aortic plaque at 3 T

PURPOSE: To evaluate the feasibility of an optimized bright blood MRI protocol at 3 T in combination with contrast agent administration for the detection and characterization of aortic high-risk plaques for the improved workup of acute stroke patients. MATERIALS AND METHODS: ECG synchronized T1-weighted 3D gradient echo MRI was performed in 45 acute stroke patients. Data were acquired with high near isotropic spatial resolution (approximately 1 mm(3)) covering the entire thoracic aorta. To compensate for breathing and vessel motion artifacts, images were collected using respiratory navigator gating in combination with short diastolic data acquisition windows adjusted on a patient-by-patient basis. In patients with aortic plaques > or =3 mm in thickness, gadolinium contrast agent was administered and both pre- and post-contrast T1-weighted 3D measurements with identical vessel coverage were performed. RESULTS: Bright blood 3D MRI detected 33 high-risk plaques with an average maximum plaque thickness of 4.2+/-1.0 mm in 23 of 45 acute stroke patients. The availability of pre- and post-contrast images acquired within the same session enhanced the identification of calcified plaque components in 77% of all analyzed plaques: post-contrast MRI clearly improved the delineation of hypointense plaque cores in 23 of 30 cases and assisted in the classification of core shape and of core fraction. CONCLUSION: 3D bright blood MRI at 3 T was feasible for the detection of aortic high-risk sources and may help to improve the detection of causes of cerebral embolism in acute stroke patients.     

Risks of Muscle Atrophy in Patients with Malignant Lymphoma after Autologous Stem Cell Transplantation

Objective: Muscle atrophy is associated with autologous stem cell transplantation (ASCT)-related outcomes in patients with malignant lymphoma (ML). However, the impact of ASCT on muscle mass remains unclear in patients with ML. The aims of this study were to investigate changes in muscle mass and risk profiles for muscle atrophy after ASCT. Method: We enrolled 40 patients with refractory ML (age 58 [20-74] years, female/male 16/24, body mass index (BMI) 21.1 kg/m² [17.1-29.6]). Psoas muscle mass was assessed using the psoas muscle index (PMI) before and after ASCT. Statistical analysis used: Independent factors associated with a severe decrease rate of change in PMI were evaluated by decision-tree analysis, respectively. Results: PMI was significantly decreased after ASCT (4.61 vs. 4.55 cm²/m²; P=0.0425). According to the decision-tree analysis, the regimen was selected as the initial split. The rates of change in PMI were −5.57% and −3.97% for patients administered MCEC and LEED, respectively. In patients who were administered LEED, the second branching factor was BMI. In patients with BMI < 20.3 kg/m², the rate of change in PMI was −7.16%. On the other hand, the rate of change in PMI was 4.05% for patients with BMI ≥ 20.3 kg/m². Conclusion: We demonstrated that muscle mass decreased after ASCT in patients with ML. Patients who received MCEC and patients with low BMI were at risk for a decrease in muscle mass.     

Exploratory voxel-based analysis of diffusion indices and hemispheric asymmetry in normal aging

Age-related microstructural changes in brain white matter can be studied by utilizing indices derived from diffusion tensor imaging (DTI): apparent diffusion coefficient (ADC) and fractional anisotropy (FA). The objective of this study is to examine alterations in FA and ADC by employing exploratory voxel-based analysis (VBA) and region(s) of interest (ROI)-based analysis. A highly nonlinear registration algorithm was used to align the ADC and FA image volumes of different subjects to perform accurate voxel-level statistics for two age groups, as well as for hemispheric asymmetry for both age groups. VBA shows significant age-related decline in FA with frontal predominance (frontal white matter, and genu and anterior body of the corpus callosum), superior portions of a splenium and highly oriented fibers of the posterior limb of the internal capsule and the anterior and posterior limbs of the external capsule. Hemispheric asymmetry of FA, as assessed by VBA, showed that for the young-age group, significant right-greater-than-left asymmetry exists in the genu, splenium and body of the corpus callosum and that left-greater-than-right asymmetry exists in the anterior limb of the external capsule and in the posterior limb of the internal capsule, thalamus, cerebral peduncle and temporal-parietal regions. VBA of the hemispheric asymmetry of the middle-age group revealed much less asymmetry. Regions showing age-related changes and hemispheric asymmetry from VBA were, for a majority of the findings, in conformance with ROI analysis and with the known pattern of development and age-related degradation of fiber tracks. The study shows the feasibility of the VBA of DTI indices for exploratory investigations of subtle differences in population cohorts, especially when findings are not localized and/or known a priori.     

Recovery process of respiratory muscle strength in patients following stroke: A Pilot Study

Objective: To determine the recovery process of respiratory muscle strength during 3 months following stroke, and to investigate the association of change in respiratory muscle strength and physical functions. Additionally, we compared respiratory muscle strength with those of healthy subjects. Method: In this prospective, observational study, 19 stroke patients and 19 healthy subjects were enrolled. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), motricity index, trunk control test, 6-minute walk test (6MWT) and functional independence measure were assessed at 1, 2, and 3 months from stroke onset in stroke patients. MIP and MEP were assessed at arbitrary times in healthy subjects. Repeated one-way analysis of variance with Bonferroni post-hoc test was used to compare the change in respiratory muscle strength in each period in stroke patients. Pearson''s correlation coefficient was computed for changes in respiratory muscle strength and physical functions. Student''s t-test was used to compare respiratory muscle strength between stroke patients at 3 months from onset and healthy subjects. Results: MIP was significantly increased at 3 months compared to 1 month. MEP was significantly increased in 2 months and 3 months, compared to 1 month. MIP changes associated with 6MWT changes. Compared to healthy subjects, MIP and MEP at 3 months were significantly lower in stroke patients. Conclusion: Respiratory muscle strength significantly increased during 3 months following stroke. However, the trend of recovery may be different. MIP changes may associated with walking endurance changes. During 3 months following stroke, respiratory muscle strength did not recover to healthy subjects.     

Kinesio Taping Application in Dysphonic Singers

IntroductionKinesio Taping (KT) application in speech therapy has been studied in a few works about dysphonia, facial nerve palsy, sialorrhea, atypical deglutition, postsurgical recovery after thyroidectomy and laryngectomy. The aim of this study was the evaluation of the possible role of KT in supporting speech therapy in singers complaining of dysphonia using singing voice handicap index (SVHI), fundamental frequency (F0), shimmer, jitter and harmonic to noise ratio (mean H/N).Materials and methodsWe enrolled consecutive singers and singing students complaining of dysphonia and voice problems. Control group (DG1) was composed of 15 individuals who underwent traditional speech therapy only, while Case group (DG2), also composed of 15 subjects, underwent traditional speech therapy associated with KT application. A computerized voice analysis was conducted using PRAAT software observing F0, jitter, shimmer and mean H/N before (t1), at mid (t2) and after (t3) the treatment. Moreover, each patient filled in the SVHI before (t1) and after (t3) the complete speech therapy treatment.ResultsThe mean F0 and H/N measured before, during and after the logopedic treatment, showed a notable increase over time (P value <0.001) both for DG1 and DG2. However, no significant difference was found comparing the two groups. Jitter and Shimmer after treatment were clearly seen to be lower than before in both groups (P value <0.001), and followed a significantly different trend over time (P value <0.001). Moreover, unlike F0 and mean H/N, these parameters underwent a significantly greater decrease in DG2 compared to DG1. Lastly, SVHI improved at t₃ and although these reductions were clear in both groups, it was greater in DG2 than in DG1.Discussion and ConclusionsOur findings are encouraging and suggest the possibility of using KT in case of vocal pathologies in singers. It is imperative to underline that the tape does not replace speech therapy, but could possibly enhance the effects of the treatment.     

煤系针状焦微晶结构的XRD与Raman分峰拟合定量研究

采用XRD和Raman光谱分析技术,结合分峰拟合的数学方法,对不同生产厂家的三种煤系针状焦Coke-N,Coke-H,Coke-P进行了研究。由XRD分析结果计算出了三种针状焦的石墨化度、晶体结构类型以及晶粒尺寸(La和Lc),通过对XRD的分峰拟合处理,得出了三种针状焦中趋于规整结构的碳微晶含量(Ig)。通过对样品的XRD分析可知,Coke-N和Coke-P的石墨化程度及Lc相接近,并且明显大于Coke-H;La之间的关系为:Coke-NCoke-PCoke-H。通过Raman光谱结合分峰拟合的数学方法对样品进行了定量分析。研究结果表明,三种针状焦在拉曼位移1 000~2 000cm-1处有5个一阶谱拟合峰(G,D1,D2,D3,D4)。对样品的拉曼一阶谱拟合后所得出的每个拟合峰面积进行计算,可以用来定量分析三种针状焦中碳微晶结构的分布情况。由I_G/I_(All),I_(D1)/I_G,I_(D2)/I_G,I_(D3)/I_G,I_(D4)/I_G的计算可知,Coke-N和Coke-P的微晶结构比Coke-H的微晶结构更规整。在Coke-N中理想石墨碳微晶所占比例为0.33,而Coke-H和Coke-P分别为0.086和0.311。另外,Coke-H在三个样品中的无定形碳比例明显大于另外两个样品。Raman光谱分析结果与XRD的分析结果相吻合。由此可以看出,采用XRD和拉曼光谱分析技术可以从微观层面判定宏观质量不同的煤系针状焦差异的实质。     

A novel 10-nm physical gate length double-gate junction field effect transisto

A novel double-gate （DG） junction field effect transistor （JFET） with depletion operation mode is proposed in this paper. Compared with the conventional DG MOSFET, the novel DG JFET can achieve excellent performance with square body design, which relaxes the requirement on silicon film thickness of DG devices. Moreover, due to the structural symmetry, both p-type and n-type devices can be realized on exactly the same structure, which greatly simplifies integration. It can reduce the delay by about 60% in comparison with the conventional DG MOSFETs.     

激光诱导击穿光谱分析系统中微型同步时序发生器研制

在激光诱谱导击穿光谱技术(laser-induced breakdown spectroscopy,LIBS)中,元素特征光谱信号强度和信噪比在不同采集延时下具有显著差异,直接影响定量分析的结果。LIBS分析系统通常采用通用型延时发生器来控制采集延时,然而其体积大、功耗高、价格昂贵,不利于LIBS仪器的小型化和便携化。为此,采用单片微控制器芯片和简单外围电路设计实现了具有55 ps可调延时精度的多通道微型同步时序发生器(简称LDG3.0),大幅度降低了同步时序发生器的体积、功耗和成本。对比LDG3.0与一种典型通用延时发生器DG535作为同步时序发生器的LIBS系统,以钒钛生铁中微量钒(V)元素定量检测为例进行两种同步时序发生器性能分析。结果表明,采用LDG3.0和DG535的LIBS系统建立的V元素定标曲线拟合系数R2均大于0.997,前者的平均相对标准偏差ARSD略小于后者,达到2.28%;前者检测极限LoD略低于后者,达到19.90 μg·g-1。因此,自主设计的同步时序发生器LDG3.0与DG535在LIBS系统中的精度基本一致,完全满足LIBS系统的实际控制和集成应用需求,特别适合于体积与功耗受限的LIBS仪器。     

Sit-to-walk Task in Hemiplegic Stroke Patients: Relationship between Movement Fluidity and the Motor Strategy in Initial Contact

Purpose: Generally, stroke patients can walk and stand up fluidly but fulfill the sit-to-walk (STW) task with difficulty. The purpose of this study was to investigate the relationship between movement fluidity and motor strategy in the initial contact of the STW task. Method: Thirty stroke patients and ten healthy subjects performed the STW task from a sitting position, and their movement was measured by a motion analysis system. The differences in data between patients and healthy subjects were analyzed using the Mann-Whitney U test. The relationship between fluidity index (FI) and other indices (kinetic and kinematic data in STW, functional independence measure [FIM], and Fugl-Meyer Assessment [FMA]) were analyzed using Spearman''s rank correlation coefficient. Results: The stroke patients had lower FI values than the healthy subjects and exhibited shortened step length and prolonged duration from onset to the first stance leg off. FI values correlated with trunk flexure angle at initial contact, first step length, and maximum vertical floor reaction force. The independent level of the FIM of stair climbing and walking ability and the FMA of balance also correlated with FI. Conclusion: There is a possibility that poor balance is one of the reasons why stroke patients are unable to start walking fluently from the sitting position. To perform the STW fluidly, patients must start walking before the trunk extension is fully completed. The relationship between FI and indices of physical ability, namely stair climbing and balance, may have therapeutic benefits for coaching the STW task to stroke patients.     

Synchrony of hand-foot coupled movements: is it attained by mutual feedback entrainment or by independent linkage of each limb to a common rhythm generator?

Background  

Synchrony of coupled oscillations of ipsilateral hand and foot may be achieved by controlling the interlimb phase difference through a crossed kinaesthetic feedback between the two limbs, or by an independent linkage of each limb cycle to a common clock signal. These alternative models may be experimentally challenged by comparing the behaviour of the two limbs when they oscillate following an external time giver, either alone or coupled together.     

Relationship between first mobilization following the onset of stroke and clinical outcomes in patients with ischemic stroke in the general ward of a hospital: A cohort study

Objective: The purpose of this study was to compare the effects of first mobilization following a stroke with independently performing the activities of daily living at discharge in acute phase ischemic stroke patients in a general ward of a hospital. Methods: A total of 158 patients with ischemic strokes were admitted to a general ward from June 1, 2014 to March 31, 2015. Of the 158 patients, 53 met the study''s eligibility criteria. First mobilization was defined as the transfer of a patient from the bed to a wheelchair by a rehabilitation therapist. A favorable primary outcome at discharge was defined as a modified Rankin Scale score of < 3. The outcome was analyzed using the proportional hazards analysis and receiver operating characteristic curves. Results: The age of the participants was 78.2 ± 11.7 years, stroke severity evaluated by the National Institutes of Health Stroke Scale scores on admission was 14.3 ± 10.6 points, and first mobilization of this population was 6.4 ± 5.2 days. Thirteen [25%] patients had a favorable outcome. Hazards analysis showed a favorable outcome due to first mobilization (adjusted hazards ratio 0.80, 95% confidence interval 0.65-0.98; p < 0.05). The cutoff point for first mobilization to produce a favorable outcome was 6.5 days after the stroke onset (area under the curve 0.729; p < 0.05). Conclusion: As seen in stroke units, early first mobilization is associated with improved clinical outcomes in ischemic stroke patients admitted to a general ward.