Impact of COVID-19 on Individuals with TBI: Nationwide Cross-Sectional Study...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

To investigate the impact of the COVID-19 pandemic on the health and life quality of individuals living with traumatic brain injury (TBI) in the United States. Cross-Sectional. General community. 1,440 adults with mild (49%), moderate (22%), and severe (29%) TBI. 3,857 adults from general population. N/A. Self-report measures of extent to which pandemic/stay-at-home orders have impacted mental health, isolation, financial stress, and access to medical care;brief assessment of vaccine hesitancy. Self-report psychometric measures of depression (PHQ-9), anxiety (GAD-7), comorbid disease burden, substance use, and domestic violence victimization. In this diverse nationwide sample, 55% of individuals with TBI lost wages due to the COVID-19 pandemic;only 16% felt they were able to pay for basic needs (food, shelter, heat). Those with TBI reported substantially elevated worry and isolation;29% reported their cognitive function and 36% felt their mood (36%) had changed due to social-distancing and/or shelter-in-place orders. The majority met criteria for clinically significant depression (78%) and/or anxiety (76%). Only 11% reported increased alcohol use, and 24% reduced use;however, 24% reported high-risk prescription pain medication use. Recent physical and verbal violence was common: only 30% indicating that others "never" physically hurt them, and only 42% said they were "never" verbally abused. Control comparison data suggest disproportionate burden among those with TBI. Individuals with TBI are at unique risk for financial loss, unmet care needs, medication misuse, and domestic violence during the ongoing pandemic. The extent to which observed disparities among those with TBI are limited to the early stages of the pandemic (i.e., 2020-2021) warrants further investigation;regardless, immediate remediation is required. None.

Impact of COVID-19 on Individuals with TBI: Nationwide Cross-Sectional Study

To investigate the impact of the COVID-19 pandemic on the health and life quality of individuals living with traumatic brain injury (TBI) in the United States. Cross-Sectional. General community. 1,440 adults with mild (49%), moderate (22%), and severe (29%) TBI. 3,857 adults from general population. N/A. Self-report measures of extent to which pandemic/stay-at-home orders have impacted mental health, isolation, financial stress, and access to medical care;brief assessment of vaccine hesitancy. Self-report psychometric measures of depression (PHQ-9), anxiety (GAD-7), comorbid disease burden, substance use, and domestic violence victimization. In this diverse nationwide sample, 55% of individuals with TBI lost wages due to the COVID-19 pandemic;only 16% felt they were able to pay for basic needs (food, shelter, heat). Those with TBI reported substantially elevated worry and isolation;29% reported their cognitive function and 36% felt their mood (36%) had changed due to social-distancing and/or shelter-in-place orders. The majority met criteria for clinically significant depression (78%) and/or anxiety (76%). Only 11% reported increased alcohol use, and 24% reduced use;however, 24% reported high-risk prescription pain medication use. Recent physical and verbal violence was common: only 30% indicating that others "never" physically hurt them, and only 42% said they were "never" verbally abused. Control comparison data suggest disproportionate burden among those with TBI. Individuals with TBI are at unique risk for financial loss, unmet care needs, medication misuse, and domestic violence during the ongoing pandemic. The extent to which observed disparities among those with TBI are limited to the early stages of the pandemic (i.e., 2020-2021) warrants further investigation;regardless, immediate remediation is required. None.

Neuropathology of Pediatric SARS-CoV-2 Infection in the Forensic Setting: Novel Application of Ex Vivo Imaging in Analysis of Brain Microvasculature

Two years into the COVID-19 pandemic, there are few published accounts of postmortem SARS-CoV-2 pathology in children. We report 8 such cases (4 infants aged 7–36 weeks, 4 children aged 5–15 years). Four underwent ex vivo magnetic resonance neuroimaging, to assist in identification of subtle lesions related to vascular compromise. All infants were found unresponsive (3 in unsafe sleeping conditions);all but 1 had recent rhinitis and/or influenza-like illness (ILI) in the family;1 had history of sickle cell disease. Ex vivo neuroimaging in 1 case revealed white matter (WM) signal hyperintensity and diffuse exaggeration of perivascular spaces, corresponding microscopically to WM mineralization. Neurohistology in the remaining 3 infants variably encompassed WM gliosis and mineralization;brainstem gliosis;perivascular vacuolization;perivascular lymphocytes and brainstem microglia. One had ectopic hippocampal neurons (with pathogenic variant in DEPDC5). Among the children, 3 had underlying conditions (e.g., obesity, metabolic disease, autism) and all presented with ILI. Three had laboratory testing suggesting multisystem inflammatory syndrome (MIS-C). Two were hospitalized for critical care including mechanical ventilation and extracorporeal membrane oxygenation (ECMO);one (co-infected with adenovirus) developed right carotid stroke ipsilateral to the ECMO cannula and the other required surgery for an ingested foreign body. Autopsy findings included: acute lung injury in 3 (1 with microthrombi);and one each with diabetic ketoacidosis and cardiac hypertrophy;coronary and cerebral arteritis and aortitis, resembling Kawasaki disease;and neuronal storage and enlarged fatty liver. All 4 children had subtle meningoencephalitis, focally involving the brainstem. On ex vivo neuroimaging, 1 had focal pontine susceptibility with corresponding perivascular inflammation/expanded perivascular spaces on histopathology. Results suggest SARS-CoV-2 in infants may present as sudden unexpected infant death, while in older children, signs and symptoms point to severe disease. Underlying conditions may predispose to fatal outcomes. As in adults, the neuropathologic changes may be subtle, with vascular changes such as perivascular vacuolization and gliosis alongside sparse perivascular lymphocytes. Detection of subtle vascular pathology is enhanced by ex vivo neuroimaging. Additional analysis of the peripheral/autonomic nervous system and investigation of co-infection in children with COVID-19 is necessary to understand risk for cardiovascular collapse/sudden death.

Changes in alcohol use and mood during the COVID-19 pandemic among individuals with traumatic brain injury: A difference-in-difference study.

OBJECTIVE: To evaluate the impact of COVID-19 pandemic exposure on changes in alcohol use and mood from years 1 to 2 after traumatic brain injury (TBI). METHODS: We used a difference-in-difference (DiD) study design to analyze data from 1,059 individuals with moderate-to-severe TBI enrolled in the TBI Model Systems (TBIMS) National Database. We defined COVID-19 pandemic exposure as participants who received their year 1 post-injury interviews prior to January 1, 2020, and their year 2 interview between April 1, 2020 and January 15, 2021. Pandemic-unexposed participants had both year 1 and 2 follow-up interviews before January 1, 2020. We measured current alcohol use as any past month alcohol use, average number of drinks per drinking occasion, and past month binge drinking. We measured depression symptoms using Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7. RESULTS: We found persons with TBI exposed to the pandemic had greater increases in the average number of drinks per occasion from year 1 to 2 post-injury compared to pandemic-unexposed individuals (ß = 0.36, 95% CI: 0.16, 0.57, p = 0.001), with males, adults <65 years old, and Black and Hispanic subgroups showing the greatest increases in consumption. Though average consumption was elevated, changes in rates of any alcohol use or binge drinking by pandemic exposure were not observed. Overall, there were no significant changes in depressive and anxiety symptoms over time between pandemic exposed and unexposed groups; however, pandemic-exposed Hispanics with TBI reported significant increases in anxiety symptoms from year-1 to year-2 post-injury compared to pandemic-unexposed Hispanics (ß = 2.35, 95% CI: 0.25, 4.47, p = 0.028). CONCLUSION: Among persons living with TBI, those exposed to the pandemic had significant increases in average alcohol consumption. Pandemic-exposed Hispanics with TBI had large elevations in anxiety symptoms, perhaps reflecting health inequities exacerbated by the pandemic, and suggesting a need for targeted monitoring of psychosocial distress.

Challenges and Lessons Learned for Acute Inpatient Rehabilitation of Persons With COVID-19: Clinical Presentation, Assessment, Needs, and Services Utilization.

OBJECTIVE: The aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post-COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions. DESIGN: For this clinical descriptive retrospective study, data were extracted from post-COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1-June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned. RESULTS: The COVID-19 patients (N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data. CONCLUSIONS: The COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.

Postintensive Care Syndrome in Survivors of Critical Illness Related to Coronavirus Disease 2019: Cohort Study From a New York City Critical Care Recovery Clinic.

OBJECTIVE: Determine the characteristics of postintensive care syndrome in the cognitive, physical, and psychiatric domains in coronavirus disease 2019 ICU survivors. DESIGN: Single-center descriptive cohort study from April 21, to July 7, 2020. SETTING: Critical care recovery clinic at The Mount Sinai Hospital in New York City. PATIENTS: Adults who had critical illness due to coronavirus disease 2019 requiring an ICU stay of 7 days or more and who agreed to a telehealth follow-up in the critical care recovery clinic 1-month post hospital discharge. INTERVENTIONS: None. MEASURES AND MAIN RESULTS: Patient-reported outcome measures assessing physical and psychiatric domains were collected electronically, a cognitive test was performed by a clinician, and clinical data were obtained through electronic medical records. Outcome measures assessed postintensive care syndrome symptoms in the physical (Modified Rankin Scale, Dalhousie Clinical Frailty Scale, Neuro-Quality of Life Upper Extremity and Lower Extremity Function, Neuro-Quality of Life Fatigue), psychiatric (Insomnia Severity Scale; Patient Health Questionnaire-9; and Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and cognitive (Telephone Montreal Cognitive Assessment) domains. The 3-Level Version of Euro-QoL-5D was used to assess the physical and psychiatric domains. A diagnosis of postintensive care syndrome was made in cases with evidence of impairment in at least one postintensive care syndrome domain. We included 45 patients with a mean (sd) age of 54 (13) years, and 73% were male. Ninety-one percent of coronavirus disease 2019 ICU survivors fit diagnostic criteria for postintensive care syndrome. 86.7 % had impairments in the physical domain, 22 (48%) reported impairments in the psychiatric domain, and four (8%) had impairments on cognitive screening. We found that 58% had some degree of mobility impairment. In the psychiatric domain, 38% exhibited at least mild depression, and 18 % moderate to severe depression. Eighteen percent presented Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores suggestive of posttraumatic stress syndrome diagnosis. In the Telephone Montreal Cognitive Assessment, 9% had impaired cognition. CONCLUSIONS: Survivors of critical illness related to coronavirus disease 2019 are at high risk of developing postintensive care syndrome. These findings highlight the importance of planning for appropriate post-ICU care to diagnose and treat this population.

Multisensory, Nature-Inspired Recharge Rooms Yield Short-Term Reductions in Perceived Stress Among Frontline Healthcare Workers.

We are currently facing global healthcare crisis that has placed unprecedented stress on healthcare workers as a result of the coronavirus disease 2019 (COVID-19). It is imperative that we develop novel tools to assist healthcare workers in dealing with the significant additional stress and trauma that has arisen as a result of the pandemic. Based in research on the effects of immersive environments on mood, a neuroscience research laboratory was rapidly repurposed using commercially available technologies and materials to create a nature-inspired relaxation space. Frontline healthcare workers were invited to book 15-min experiences in the Recharge Room before, during or after their shifts, where they were exposed to the immersive, multisensory experience 496 Recharge Room users (out of a total of 562) completed a short survey about their experience during an unselected, consecutive 14-day period. Average self-reported stress levels prior to entering the Recharge Room were 4.58/6 (±1.1). After a single 15-min experience in the Recharge Room, the average user-reported stress level was significantly reduced 1.85/6 (±1.2; p < 0.001; paired t-test). Net Promoter Score for the experience was 99.3%. Recharge Rooms such as those described here produce significant short-term reductions in perceived stress, and users find them highly enjoyable. These rooms may be of general utility in high-stress healthcare environments.