COVID-19 Presentation in an Acute Motor Incomplete Spinal Cord Injury in Inpatient Rehabilitation

Abstract

Spinal cord injuries lead to impairment of the central regulation of respiratory muscle activity. This impairs the cough response, which can increase the risk of complications if infected with coronavirus disease 2019. This case describes a 32-yr-old man with an acute traumatic motor incomplete spinal cord injury, C4 American Spinal cord Injury Association Impairment Scale D D, in an inpatient rehabilitation facility who presented with only a fever. Initial infectious workup was negative, and he continued to have elevated temperatures with no other symptoms. He was then tested for coronavirus disease 2019 and found to be positive. This is the first documented case that identifies this potentially lethal disease in an acute motor incomplete spinal cord injury in an inpatient rehabilitation setting. We further discuss how physiatrists need to be aware of milder presentation of coronavirus disease 2019 in patients with spinal cord injuries. Inability to recognize this disease can lead to delayed diagnosis and asymptomatic spread in an inpatient rehabilitation setting.

The Impact of COVID-19 on Epidemiological Features of Spinal Cord Injury in Wuhan, China: A Comparative Study in Different Time Periods

“…Data on the occurrence of SCI worldwide before and after the COVID-19 pandemic are limited. Nonetheless, it was estimated that the incidence rate of traumatic SCI in China was 23.1 cases per million population per year before the pandemic [1,3]. In other countries, the incidence rates of SCI widely vary.…”

“…Despite the challenges arising from the COVID-19 pandemic, rehabilitation remains a critical component of care after SCI treatment. Rehabilitation can improve motor-sensory function, QOL, and prevent long-term complications, such as pressure ulcers and musculoskeletal complications [3]. In recent years, there has been a rise in new techniques in SCI rehabilitation [7,8], such as new research on the use of robotic technology in rehabilitation departments after SCI treatment [7][8][9][10][11], as well as the cooperation of multidisciplinary teams in providing high-quality care to the SCI patients [12].…”