Rehabilitation processes, stress and depression in patients with spinal cord injury during the COVID-19 pandemic in Turkey: a telephone survey

Background/Aims Spinal cord injury is a chronic disease that can develop various complications and multisystem dysfunctions. Patients with spinal cord injury need long-term follow up and rehabilitation. During the COVID-19 pandemic, people had to observe social distancing and stay at home. The aim of this study was to evaluate the effects of the COVID-19 pandemic on the rehabilitation and health status of patients with spinal cord injury and assesses their stress levels and depression status. Methods A telephone-based survey was conducted with patients followed up by a spinal cord injury outpatient clinic about rehabilitation processes and any health problems experienced. Stress levels were assessed using the Perceived Stress Scale, while depression was assessed using the Beck Depression Inventory. Demographic characteristics, American Spinal Injury Association Impairment Scale levels, Functional Ambulation Categories and Spinal Cord Independence Measure scores were retrieved from the patients' files. Results The study included 115 patients, none of whom had contracted COVID-19. Of these patients, 44.3% joined the rehabilitation programme before the pandemic, and 3.5% had been able to participate in the rehabilitation programme during the pandemic. An increase in spasticity was recorded in 43.5% of the respondents, an increase of neuropathic pain was recorded in 37.4% of patients and complaints of neurogenic bladder and neurogenic bowel increased by 26.1% and 16.5% respectively. In addition, 4.3% reported novel decubitus ulcers, while 5.2% reported having experienced autonomic dysreflexia episodes. The Perceived Stress Scale scores were 18.32 ± 5.91. No significant difference was detected between the Beck Depression Inventory scores taken at the time of the study and those recorded before the pandemic. Conclusions An insufficiency in the rehabilitation process was noted among patients with spinal cord injuries, accompanied by increased complications. New approaches need to be developed to ensure that the rehabilitation processes of patients with spinal cord injury are not interrupted during a pandemic, and that patients' mental health is not ignored.

Is there a relationship between vitamin D levels, inflammatory parameters, and clinical severity of COVID-19 infection?

OBJECTIVES: This study is aimed to determine the relationship between 25-OH vitamin D levels, inflammatory parameters of neutrophil­to­lymphocyte ratio (NLR), platelet­to­lymphocyte ratio (PLR), c­reactive protein (CRP) levels and the disease severity of COVID-19 infection. BACKGROUND: Inflammation plays a key role in the pathogenesis of COVID-19 while identifying the clinical course and prognosis. The effect of vitamin D deficiency on contribution to inflammation in COVID-19 is unclear. METHODS: Based on the classification of the clinical course of COVID-19, the patients were divided into three groups, i.e., with mild (Group 1), moderate (Group 2) and severe/critical cases (Group 3). The 25-OH vitamin D values were defined as deficient, insufficient or normal. RESULTS: There were no statistically significant differences in the distribution rates of 25-OH vitamin D levels (p>0.05) between the groups. Inflammatory parameters in Group 3 were statistically significantly higher as compared to Groups1 and 2 (p<0.05). Multivariate logistic regression analysis revealed that NLR was an independent predictor of disease severity. CONCLUSION: There is no relationship between the severity of COVID-19 infection and 25-OH vitamin D deficiency. Inflammatory parameters are associated with the disease severity, while NLR is an independent predictor of severe COVID-19. There was no correlation between 25-OH vitamin D and inflammatory markers (Tab. 4, Fig. 1, Ref. 38).

Rehabilitation status of children with cerebral palsy and anxiety of their caregivers during the COVID-19 pandemic.

OBJECTIVE: The purpose of the study is to explore the rehabilitation status of children with cerebral palsy (CP) and anxiety level of their caregivers during the Coronavirus disease-2019 (COVID-19) pandemic. METHODS: Caregivers of children with CP who were being followed up in our outpatient CP clinic were contacted between May 28 and June 26, 2020. Two hundred and six caregivers who voluntarily agreed to participate were administered the State-Trait Anxiety Inventory and were questioned about the rehabilitation status of their children. Demographic data, other health problems, Gross Motor Function Classification System, and Manual Ability Classification System levels of children were recorded from their files. RESULTS: All children were at home with their families during the pandemic. Their mean age was 9.58±3.84 years. One hundred and ninety-nine children were going to the rehabilitation center before the pandemic, only three children went to the rehabilitation center twice a week during the pandemic period. The anxiety level of all the caregivers was found to be high. Trait anxiety of the caregivers who did not perform home exercise to their children were found to be statistically significantly higher than those who performed exercise (p<0.05). CONCLUSION: Rehabilitation strategies should focus on reducing anxiety level in caregivers of children with CP and effective homecare therapy techniques should be acquired by the caregivers.

Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.