‘Online therapy’ to reduce caregiver’s distress and to stimulate post-severe acquired brain injury motor and cognitive recovery: A Sicilian hospital experience in the COVID era

Abstract

Introduction Severe acquired brain injury(SABI) often results in the deterioration of physical, cognitive and emotional functions in the patient and a significant caregiver's distress syndrome, which is now amplified by the social isolation, depression and financial difficulties related to the COVID-19 pandemic. The use of web-based online-therapy has been shown to be useful to overcome caregiver's distress syndrome and further stimulate cognitive-motor recovery of SABI-patients. Our study aimed to investigate whether a systematic online Skype-therapy(OLST) may be of support in favoring global cognitive and sensory-motor recovery in SABI-patients and reducing caregiver distress. Methods Twenty-five SABI-subjects in inpatient regimen were provided with intensive OLST with the caregiver for 12 weeks in addition to standard neurorehabilitation. Each subject and caregiver was evaluated before and after the treatment by administering an ad hoc battery. Furthermore, 18 of 27 patients were provided with EEG recording in resting state. Results We found a significant reduction in caregiver's anxiety (p<0.0001) and burden(p<0.0001). Patients showed significant improvement in trunk control (p<0.0001), functional independence (p = 0.005), functional (p = 0.01) and global communication (p = 0.004), cognitive functioning (p = 0.001), and behavioral responsiveness (p = 0.0004). The training yielded a significant connectivity change within the fronto-centro-parietal areas in the delta frequency band (p<0.0001) and the centro-parieto-occipital areas in the alpha range (p = 0.004). Discussion OLST may be a useful and complementary treatment to optimize global cognitive and functional recovery in SABI-subjects and reduce caregivers' concerns in the Covid-era. OLST can foster cognitive-motor recovery potentially by favoring the plasticity-dependent functional recovery. Therefore, OLST could be proposed as a tool allowing social conversations also in the hospital setting.

Psychological Support Interventions for Healthcare Providers and Informal Caregivers during the COVID-19 Pandemic: A Systematic Review of the Literature

“…The selected studies were conducted in China [ 3 , 24 , 40 ] and Italy [ 32 , 41 ]. Three contributions made use of a one-group, pre–post study design [ 24 , 32 , 41 ], while in two records [ 3 , 40 ] a pre–post comparative design was adopted. The sample size varied widely among studies, from a minimum of 34 [ 32 ] to a maximum of 508 [ 3 ] participants.…”

“…All the investigations included participants of both genders, with a mean age ranging from 31 [ 32 ] to 72 years [ 40 ]. The length of the intervention ranged from 4 [ 3 ] to 12 weeks [ 41 ]. The recipients of support interventions were HCPs assisting COVID-19 patients in two studies [ 24 , 32 ] and informal caregivers assisting people suffering from mental disorders in three studies [ 3 , 40 , 41 ].…”

“…Five records ultimately entered the systematic review [ 3 , 24 , 32 , 40 , 41 ]. The flowchart presented in Figure 1 provides step-by-step details of the study selection process.…”

“…Three out of the five selected articles [ 3 , 24 , 32 ] had a moderate methodological quality (one weak rating), while the remaining two studies [ 40 , 41 ] showed a strong methodological quality (no weak ratings). The rating of each selected study is presented in Supplementary Material Table S1 , while a Bias Analysis Graph is presented in Figure 2 .…”

“…To this aim, psychological interventions have been developed to support HCPs [ 24 , 32 ] and informal caregivers [ 3 , 40 , 41 ] during the COVID-19 pandemic. However, there is a lack of systematic evaluations of existing mental health management strategies for caregivers from the current pandemic, thus limiting the conceptualization of timely and effective actions of care.…”