COVID-19 Neuromuscular Involvement in Post-Acute Rehabilitation

Abstract

Background: Coronavirus disease 2019 (COVID-19) is associated with muscle and nerve injuries as a consequence of prolonged critical illness or the infection itself. In this study, we evaluated neuromuscular involvement in patients who underwent post-acute intensive rehabilitation after COVID-19. Methods: Clinical and neurophysiological evaluations, including nerve conduction studies and electromyography, were performed on 21 consecutive patients admitted for rehabilitation after COVID-19. Results: Clinical signs suggesting muscle or nerve involvement (weakness, reduced deep tendon reflexes, impaired sensitivity, abnormal gait) were found in 19 patients. Neurophysiological examinations confirmed neuromuscular involvement in 17 patients: a likely association of critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) was found in 5 patients; CIM alone was found in 4 patients; axonal sensory-motor polyneuropathy was found in 4 patients (CIP in 2 patients, metabolic polyneuropathy in 2 patients); Guillain-Barré syndrome was found in 2 patients (classical demyelinating sensory-motor polyneuropathy and acute motor axonal neuropathy, respectively); peroneal nerve injury was found in 1 patient; and pre-existing L4 radiculopathy was found in 1 patient. Conclusions: Neuromuscular involvement is a very common finding among patients admitted for rehabilitation after COVID-19, and proper investigation should be conducted when muscle or nerve injury is suspected for adequate rehabilitative strategy planning.

Correlations between Electro-Diagnostic Findings, the Severity of Initial Infection, and the Rehabilitation Outcomes among COVID-19 Patients

“…In our study, 47.4% of our subjects were diagnosed with myopathy. In a similar study that performed neurophysiological evaluations on COVID-19 patients ( n = 21), abnormal findings were reported in 81% of their subjects [ 5 ]. Interestingly, myopathy was also found in 11 (55%) COVID-19 patients that were examined due to sensory symptoms [ 27 ] and 6 (50%) COVID-19 patients that were asymptomatic for muscular involvement [ 28 ].…”

“…Neurological manifestation appear in approximately 36% of patients with coronavirus disease 2019 (COVID-19) [ 1 , 2 ]. Many of them manifest multiple neuromuscular complications, including widespread involvement of the peripheral nervous system, as well as the neuromuscular junction and muscles [ 3 , 4 , 5 ]. Some peripheral injuries are attributed to prolonged immobilization in intensive care units [ 6 , 7 , 8 ].…”

A bibliometric and visualized analysis of early mobilization in intensive care unit from 2000 to 2021

“…There is a growing understanding of the SARS-CoV-2 virus in the current context of COVID-19 swept worldwide ( 48 ). It is worth mentioning that this process requires us to pay attention to the changes in pulmonary function and assess the neuromuscular of the patient ( 49 ). It is expected that patients with severe COVID-19 may have musculoskeletal changes due to prolonged mechanical ventilation and restraint, with weakness and physical impairment unrelated to the primary disease process ( 50 , 51 ).…”

Post-Coronavirus Disease 2019 Triggers the Appearance of Mixed Polyneuropathy and Brain Fog: A Case Report

“…Oral mucosa, for example, has been shown to express angiotensin-converting enzyme receptor 2, which would allow viral spread through associated cranial nerves. Another mechanism of penetration into the CNS could be through the spike protein of SARS-CoV-2, which has a sequence like neurotoxins; these small peptides and those mentioned above could be responsible for the clinical manifestations observed in patients with COVID-19 [ 5 , 6 , 7 , 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…As more is learned about the COVID-19 pandemic, it has become apparent that neurological involvement in COVID-19 may be important in some patients. Neurological symptoms have been described in patients affected by COVID-19, such as headache, dizziness, memory loss, lack of concentration, myalgia and anosmia, as well as cases of encephalopathy, encephalitis, hemorrhagic necrotizing encephalopathy, stroke, epileptic seizures and rhabdomyolysis, associated with infection by SARS-CoV-2 [ 4 , 5 , 6 , 7 ]. Reports have also implicated peripheral nerve damage such as mononeuropathy and a more generalized acute polyneuropathy, most often reported as Guillain–Barre syndrome.…”