COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury

Korupolu, Radha; Stampas, Argyrios; Gibbons, Carlee; Jimenez, Isaac Hernandez; Skelton, Felicia; Verduzco‐Gutierrez, Monica

doi:10.1038/s41394-020-0284-7

Cited by 44 publications

(70 citation statements)

References 22 publications

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“…The impact of COVID-19 on individuals with SCD has been reported. However, to the best of our knowledge, SCD after COVID-19 has not been described [17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 85%

Spinal cord dysfunction after COVID-19 infection

Sampogna

Tessitore²,

Bianconi³

et al. 2020

Spinal Cord Ser Cases

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Introduction We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020. Case presentation We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4-C6 spinal epidural abscess (SEA) requiring a C3-C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1-T7 SEA. He underwent a T3-T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ). Discussion To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.

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“…The impact of COVID-19 on individuals with SCD has been reported. However, to the best of our knowledge, SCD after COVID-19 has not been described [17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 85%

Spinal cord dysfunction after COVID-19 infection

Sampogna

Tessitore²,

Bianconi³

et al. 2020

Spinal Cord Ser Cases

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“…There have been case reports of 16 individuals with SCI and concomitant COVID-19 reported thus far. While one study reported an asymptomatic case of an individual with acute SCI due to the increased screening efforts found at many hospitals [15], nine of these individuals had some form of imaging evidence indicating pneumonia [14,[16][17][18][19]. Even though pneumonia was a prevalent clinical feature of their illness, clinical symptoms such as dyspnea and cough were not as predominant as fever [14,[16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…While one study reported an asymptomatic case of an individual with acute SCI due to the increased screening efforts found at many hospitals [15], nine of these individuals had some form of imaging evidence indicating pneumonia [14,[16][17][18][19]. Even though pneumonia was a prevalent clinical feature of their illness, clinical symptoms such as dyspnea and cough were not as predominant as fever [14,[16][17][18][19]. Fever appears to be the most prevalent, and often the first symptom of COVID-19 for individuals with SCI, followed by lymphocytopenia [14,[16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…Even though pneumonia was a prevalent clinical feature of their illness, clinical symptoms such as dyspnea and cough were not as predominant as fever [14,[16][17][18][19]. Fever appears to be the most prevalent, and often the first symptom of COVID-19 for individuals with SCI, followed by lymphocytopenia [14,[16][17][18][19]. In addition, all individuals who were tracheostomy-reliant prior to COVID-19 required aspiration and hyperinflation techniques for secretion removal, when only half of them required these maneuvers prior to COVID-19 diagnosis [14].…”

Section: Introductionmentioning

confidence: 99%

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A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19

Palermo

Cahalin

Nash

2020

Spinal Cord Ser Cases

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Introduction Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC. Results of a SCI clinical trial showed a supervised respiratory muscle training (RMT) program decreased risk of developing RC. The feasibility of conducting unsupervised RMT is not well documented. Four publications (n = 117) were identified in which unsupervised RMT was performed. Significant improvements in respiratory outcomes were reported in two studies: Maximal Inspiratory and Expiratory Pressure (MIP40% and MEP25%, respectively), Peak Expiratory Flow (PEF9%), seated and supine Forced Vital Capacity (FVC23% and 26%, respectively), and Peak Cough Flow (28%). This review and case report will attempt to show that an inspiratory muscle training (IMT) home exercise program (HEP) is feasible and may prepare the respiratory system for RC associated with COVID-19 in patients with SCI. Case presentation A 23-year-old with tetraplegia (P1), history of mechanical ventilation, and hospitalization for RC, completed 27 IMT HEP sessions in one month. MIP and sustained MIP (SMIP) increased from baseline by 28% and 26.5%, respectively. Expiratory volumes and rates also improved (FVC, FEV1, and PEF: 11.7%, 8.3%, and 14.2%, respectively). Discussion The effects of COVID-19 on patients with SCI remains inconclusive, but recent literature and the results of this case suggest that unsupervised IMT is feasible and may limit the severity of RC in patients with SCI who contract COVID-19.

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“…The baseline comorbidities that people with SCI commonly have such as frequent urinary tract infections, respiratory disorders, propensity for febrile illness, and varied presentations of illness make diagnosis more difficult than in able-bodied individuals. In response, Korupolu et al [2] do an excellent job summarizing the potential impacts of COVID-19 on persons with SCIs and the special care that must be taken in triaging that is important to read.…”

mentioning

confidence: 99%

Pandemics, climate change, and disability related to SCI

Alexander

2020

Spinal Cord Ser Cases

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COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury

Cited by 44 publications

References 22 publications

Spinal cord dysfunction after COVID-19 infection

Spinal cord dysfunction after COVID-19 infection

A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19

Pandemics, climate change, and disability related to SCI

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