Chronic phase of COVID-19: physical therapist´s challenges in the face of neurological events

Abstract

Chronic phase of COVID-19: physical therapist´s challenges in the face of neurological events Fase crônica da COVID-19: desafios do fisioterapeuta diante das manifestações neurológicas The COVID-19 began in the city of Wuhan, China, in December 2019, and it's caused by a newly discovered coronavirus, the SARS-COV-2. Soon after, the COVID-19 epidemic in China became a pandemic with significant burdens on healthcare and the world economy [1]. COVID-19 presents mainly as a respiratory disease, which is sometimes accompanied by gastrointestinal and musculoskeletal events [2]. According to clinical studies in Asia, the most prevalent symptoms consist of fever, cough, dyspnea, sputum production, myalgia, arthralgia, headache, diarrhea, runny nose, and sore throat [3, 4]. A retrospective study in China with more than 200 participants found that a subset of patients with COVID-19 had neurological symptoms [5]. These include impaired consciousness, acute cerebrovascular disease and musculoskeletal symptoms, suggesting the impairment of the central (CNS) and peripheral (PNS) nervous systems. The symptoms observed were more likely to be present in patients who suffered from the severe form of the disease. Another study of the same group reported that in 13 patients COVID-19 infection was followed by cerebrovascular disease, including ischemic stroke, cerebral venous sinus thrombosis (CVST), and cerebral hemorrhage [6]. The expansion of the COVID-19 infection in Europe highlighted an atypical presentation of the disease: patients with olfactory and gustatory disorders (hyposmia and hipogeusia, respectively), characterizing the involvement of the PNS. Although neurological COVID-19-related events are just beginning to be adequately studied, it is highly likely that some of these patients, particularly those suffering severely from the disease, present CNS impairment as well as neurological events such as those mentioned above. Precise and targeted documentation on neurological symptoms, detailed clinical practice, patients' neurological and electrophysiological investigations, attempts to isolate SARS-CoV-2 from cerebrospinal fluid and autopsy of COVID-19 victims can clarify the role played by this virus in neurological dysfunctions. This poses challenges for the rehabilitation of post-COVID patients. Being placed as the most evident neurological manifestation of COVID-19, and due to its classic risk factors, stroke constituted an increase in the number of patients trying to find physical therapy services, since new stroke events did not stop happening and continue to be the biggest cause of functional disability. These are people whose consequences are impairments in their muscle tone and strength, coordination, gait, and in the performance of their daily activities. Considering that so far the indications are neurological deficits generated by a stroke, but not only that, in more severe cases of COVID the rehabilitation needs greater dedication, frequency, and specialized and individualized physical therapy.

Survey on Changes in Neurophysiotherapy at a Hospital/Clinic and Home-Based Settings in India During COVID-19 Pandemic

“…On March 11, 2020, a global pandemic caused by SARS-CoV-2 (COVID- 19) was announced by the World Health Organization (WHO), which exposed the weakened healthcare sector and burdened the economic sector. 1,2 The second wave resulting from the emergence of various strains of the virus in 2021 further added to this burden. 3 Rehabilitative services were also poorly availed due to fear of contracting infection, and emphasis was laid upon availing healthcare services only when absolutely necessary or in emergency.…”

“…12,14 Thus, there is an extensive need for adaptations in our current practice including coordinated interdisciplinary team effort, greater dedication, home and community-based interventions and meeting post-discharge rehabilitation demands of patients, while maintaining near normal functional status of patients. 1,13,15 Patients with a neurological disease require physical rehabilitation from the acute to chronic phase irrespective of their COVID positive status. 16,17 Hence, the primary demand is to develop and implement uniform evidence-based clinical neurophysiotherapy guidelines including clinical monitoring systems to ensure readiness and effective planning to deal with such pandemics.…”

“…16,17 Hence, the primary demand is to develop and implement uniform evidence-based clinical neurophysiotherapy guidelines including clinical monitoring systems to ensure readiness and effective planning to deal with such pandemics. 1,15,17,18 To achieve the above-mentioned in such challenging times, it is required to evaluate the existing processes and identify the modifications needed in clinical practices in neurological physiotherapy. This would be beneficial to strategize as well as minimize the health-related adverse events in patients with neurological disorders due to the frequently imposed lockdown and its consequences.…”

“…12, 14 Thus, there is an extensive need for adaptations in our current practice including coordinated interdisciplinary team effort, greater dedication, home and community-based interventions and meeting post-discharge rehabilitation demands of patients, while maintaining near normal functional status of patients. 1, 13, 15…”

“…16, 17 Hence, the primary demand is to develop and implement uniform evidence-based clinical neurophysiotherapy guidelines including clinical monitoring systems to ensure readiness and effective planning to deal with such pandemics. 1, 15, 17, 18…”