Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic

Abstract

Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.

Coronavirus disease 2019 and acute cerebrovascular events: a comprehensive overview

“…In their study, Qureshi et al analyzed over 27,000 hospitalized patients and found that those who were diagnosed with COVID-19 and experienced an acute ischemic stroke exhibited a twofold elevation in the likelihood of being discharged to a non-home destination or death ( 106 ). The poor prognosis of COVID-19 stroke patients might be associated with more severe onset symptoms and lack of effective rehabilitation during the epidemic ( 101 ). Another explanation for the worsening stroke prognosis in COVID-19 patients is probably the diminished use of acute stroke therapies such as tissue fibrinogen activator (t-PA) and mechanical thrombectomy (MT).…”