OBJECTIVES: To investigate the effects of controlled passive stretching and active movement training using a portable rehabilitation robot on stroke survivors with ankle and mobility impairment. METHODS: Twenty-four patients at least 3 months post stroke were assigned to receive 6 week training using the portable robot in a research laboratory (robot group) or an instructed exercise program at home (control group). All patients underwent clinical and biomechanical evaluations in the laboratory at pre-evaluation, post-evaluation, and 6-week follow-up. RESULTS: Subjects in the robot group improved significantly more than that in the control group in reduction in spasticity measured by modified Ashworth scale, mobility by Stroke Rehabilitation Assessment of Movement (STREAM), the balance by Berg balance score, dorsiflexion passive range of motion, dorsiflexion strength, and load bearing on the affected limb during gait after 6-week training. Both groups improved in the STREAM, dorsiflexion active range of motion and dorsiflexor strength after the training, which were retained in the follow-up evaluation. CONCLUSION: Robot-assisted passive stretching and active movement training is effective in improving motor function and mobility post stroke.

a novel coronavirus, SARS-CoV-2 (COVID-19), began spreading rapidly throughout China and now is a global pandemic, with cases reported in over 192 countries and territories worldwide. Clinically, COVID-19 ranges from a mild, self-limiting respiratory illness to severe progressive pneumonia and multiorgan failure. The first COVID-19 case was reported at the beginning of March in New York City (NYC), and now just 3 weeks later, NYC and its suburbs have over 5% of global cases. Worldwide, there is a rapid increase in the number of cases daily, including the number of patients requiring hospitalization and intensive care support.Although our internal medicine, emergency department (ED), pulmonary/critical care, and anesthesiology colleagues are at the frontlines, neurologists are playing a critical role in patient care. Here, we describe the initial steps our department has taken to prepare for the COVID-19 outbreak. We highlight some of the steps neurology departments should urgently consider to prepare for an increased volume of patients with COVID-19 in their hospital system. This article provides a comprehensive guide for other neurology departments in terms of preparation for an influx of COVID-19-positive patients into their hospital system. General departmental initiativesAs a department, we began holding routine meetings to prepare for COVID-19 in mid-February. Multidisciplinary meetings are held with key staff including nursing leadership, intensive care leadership, inpatient and outpatient neurology department leaders, and departmental administrative leadership (table 1). At the beginning of March, we held webcasts to our department weekly, given the restrictions for large in-person gatherings to provide updates on inpatient and outpatient clinical care activities, departmental research ramp down, human resources issues, and updates on hospital and public health guidelines including key epidemiologic information around COVID-19. There was an opportunity for departmental members including support staff to ask questions around work-related concerns.Providing mental health support for the challenges we all face during this time due to social distancing and separation, child and elder care, financial, and clinical pressures was identified as an early critical component of our efforts. In addition to departmental neuropsychologists volunteering to provide free private counseling services, hospital-wide free telemental health support has also been made accessible to our department.

I n Spring 2020, New York City (NYC) rapidly became an epicenter of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) global pandemic, with a reported 200,547 cases between March 8 and May 31, 2020. 1 Over one fifth of hospitalized patients in NYC were critically ill, many on mechanical ventilation with multi-organ failure requiring prolonged sedation. 2 The neurology consultation service quickly became an integral part of the care for the many critically ill patients with COVID-19 with impaired consciousness. The mechanism of these disorders of consciousness in patients infected by COVID-19 is poorly understood and may be due to multi-organ failure, hypoxia, systemic inflammation, hypercoagulability, and possible neuro-invasion. 3 Uncertainty about the trajectory of this novel disease as well as concerns for health care worker safety created challenges in relying on standard behavioral, electrophysiological, imaging, and laboratory data that guides diagnostic workup and prognostication in patients with disorders of consciousness. To provide a comprehensive weighing of the rapidly evolving body of evidence in an area of great uncertainty, we instituted a multidisciplinary COVID-19 Coma Board modeled after the tumor board concept. 4 This biweekly, secure web-based multidisciplinary conference first met on May 13, 2020, with participants representing neurocritical care, epilepsy, stroke, neuroradiology, neurovascular, neurohospitalist, neuroinfectious disease, rehabilitation medicine, and pharmacology. Data was presented by the consult team using a standardized data collection format (Table). This study was approved by the institutional review board at Columbia University Irving Medical Center. The requirement for written informed consent was waived because the observational study design involves no more than minimal risk. In our first 8 case discussions, 5 patients were above 60 years old (53%), 3 were women (38%), 4 had episodes of hypoxia (defined as at least one documented arterial blood gas with a PO2 below 55 mmHg), 1 suffered cardiopulmonary arrest, and