Acute inpatient rehabilitation for COVID-19 survivors: A retrospective case series.

BACKGROUND: Patients with Coronavirus Disease 2019 (COVID-19) who required mechanical ventilation and had prolonged hospital stay present with medical instability and functional impairments after the acute hospitalization. OBJECTIVE: To present the rehabilitation outcome of three patients with COVID-19 admitted to an inpatient rehabilitation unit using a case series method. METHODS: Subjects included three consecutive male patients admitted to the rehabilitation unit with a diagnosis of deconditioning and critical illness myopathy. On admission, patients were evaluated by a multidisciplinary team using outcome measures such as 6-min walk test (6 MWT), 10-m walk test (10 MWT), berg balance scale (BBS), and dynamometry. Each patient received daily therapy with a minimum of 900 min per week during their rehabilitation stay. Treatment strategies included fatigue management, training of mobility and activities for daily living tasks, muscle strengthening, and cognitive retraining. RESULTS: All patients showed significant improvements across all the outcome measures, specifically, the 6MWT (minimal clinically identifiable difference (MCID) range: 14-30.5 m) and the 10MWT (MCID range: 0.10-0.20 m/s) which exceeded the MCID for all three patients. The BBS also demonstrated significant improvement, surpassing the minimum detectable change of 5-7 points. Of the three patients, two were able to be discharged at an independent level, while one required supervision for safety. CONCLUSION: Patients with COVID-19, who experienced prolonged hospital stay present with severe impairments in muscle strength, functional mobility, and participation in daily living tasks. Inpatient rehabilitation may have the potential to reduce impairments and accelerate the recovery process while managing ongoing medical issues.

The Relative Importance of Hospital Discharge and Patient Composition in Changing Post-Acute Care Utilization and Outcomes Among Medicare Beneficiaries.

Background: The COVID-19 pandemic changed care delivery. But the mechanisms of changes were less understood. Objectives: Examine the extent to which the volume and pattern of hospital discharge and patient composition contributed to the changes in post-acute care (PAC) utilization and outcomes during the pandemic. Research design: Retrospective cohort study. Medicare claims data on hospital discharges in a large healthcare system from March 2018 to December 2020. Subjects: Medicare fee-for-service beneficiaries, 65 years or older, hospitalized for non-COVID diagnoses. Measures: Hospital discharges to Home Health Agencies (HHA), Skilled Nursing Facilities (SNF), and Inpatient Rehabilitation Facilities (IRF) versus home. Thirty- and ninety-day mortality and readmission rates. Outcomes were compared before and during the pandemic with and without adjustment for patient characteristics and/or interactions with the pandemic onset. Results: During the pandemic, hospital discharges declined by 27%. Patients were more likely to be discharged to HHA (+4.6%, 95% CI [3.2%, 6.0%]) and less likely to be discharged to either SNF (-3.9%, CI [-5.2%, -2.7%]) or to home (-2.8% CI [-4.4%, -1.3%]). Thirty- and ninety-day mortality rates were significantly higher by 2% to 3% points post-pandemic. Readmission were not significantly different. Up to 15% of the changes in discharge patterns and 5% in mortality rates were attributable to patient characteristics. Conclusions: Shift in discharge locations were the main driver of changes in PAC utilization during the pandemic. Changes in patient characteristics explained only a small portion of changes in discharge patterns and were mainly channeled through general impacts rather than differentiated responses to the pandemic.

Expectations of Patients Recovering from SARS-CoV-2 towards New Forms of Pulmonary Rehabilitation.

The purpose of this study was to explore the experiences of patients attending an innovative technology-enhanced pulmonary rehabilitation program of National Health Found Program in Poland. The study included two groups of patients participating in post-COVID-19 stationary rehabilitation. Patients from group I (127 individuals) contracted COVID-19 in 2020, while patients from group II fell ill in 2021 (68 individuals). The study used a self-administered questionnaire. This study was designed as an acceptability study. In the experience related to COVID-19 in both groups of the respondents, the possibility of undertaking inpatient rehabilitation in a hospital ward played an important and positive role. Patients who experienced COVID-19 symptomatically expected that rehabilitation would eliminate the related dysfunctions, such as reduced respiratory efficiency of the lungs, disorders of the nervous system, and cognitive disorders (the so-called brain fog). All respondents who experienced symptomatic COVID-19 positively assessed the rehabilitation program offered. Among the highest-rated rehabilitation, elements were identified: exercise on a cycle ergometer implemented with video stimulation, group fitness exercises, and breathing exercises. Other innovative forms of rehabilitation were positively evaluated by 10% to 25% of patients.

First results from post-COVID inpatient rehabilitation.

Background: COVID-19 is associated with various symptoms and psychological involvement in the long term. In view of the multifactorial triggering and maintenance of the post-COVID syndrome, a multimodal therapy with somatomedical and psychotherapeutic content is expedient. This paper compares the psychological stress of post-COVID patients and their course in rehabilitation to psychosomatic and psychocardiological patients. Method: Observational study with control-groups and clinical, standardized examination: psychological testing (BDI-II, HELATH-49), 6-MWT as somatic parameter, two measurement points (admission, discharge). Sample characteristics, including work related parameters, the general symptom-load and the course of symptoms during rehabilitation are evaluated. Results: At admission in all measures post-COVID patients were significantly affected, but less pronounced than psychosomatic or psychocardiological patients (BDI-II post-COVID = 19.29 ± 9.03, BDI-II psychosomatic = 28.93 ± 12.66, BDI-II psychocardiology = 24.47 ± 10.02). During rehabilitation, in all complaint domains and sub-groups, symptom severity was significantly reduced (effect sizes ranging from d = .34 to d = 1.22). Medium positive effects were seen on self-efficacy (d = .69) and large effects on activity and participation (d = 1.06) in post-COVID patients. In the 6-MWT, the walking distance improved by an average of 76.43 ± 63.58 meters (d = 1.22). Not a single patient deteriorated in walking distance, which would have been a possible sign of post exercise malaise (PEM). Conclusion: Post-COVID patients have a slighter psychological burden as psychocardiological or psychosomatic patients. Although rehabilitation is not curative, post-COVID patients benefit significantly from the interventions and there were no signs of PEM.

Relations between indoor rehabilitation and basic health services in a developing country.

Background: and Introduction: Physical rehabilitation is vital for patients to regain maximum function. Approximately 80% of people with a disability live in developing countries, where they face multiple challenges in rehabilitation. The goal of the study was to conduct an analysis of indoor rehabilitation programs based on the demographics and medical conditions of the admitted patients and to relate to the available basic health and rehabilitation facilities. Methods: This was a mixed method study conducted in an inpatient rehabilitation ward of a tertiary level academic university hospital in a developing country. All admitted patients who stayed for a period of minimum two weeks were included in the study. Demographic and clinical data were obtained by means of a retrospective medical record review utilizing a standardized data extraction form. The study was further strengthened by an online literature search for the available documents for analysis, relation, and discussion. Results: Among the 1,309 admitted patients was male- female ratio was 10:7, with the majority (31.4%) cases falling between the ages of 46 and 60yrs. Rehabilitation outpatient department was the principal mode of admission (78%), and musculoskeletal and neurological conditions represented the maximum number (79.8%). Majority of patients (60.8%) were discharged home on completion of the rehabilitation program with a large number of patients who were absconded. Poor health budget allocation and lack of prioritization of the rehabilitation sector face multiple challenges, including the rehabilitation team functioning resources, space crisis for expansion which was further impacted by the COVID-19 pandemic. Conclusions: The country's current health-related rehabilitation process and socio-demographic variables have a negative relationship. There was a large number of missing data in the medical records and many patients were lost prematurely from the indoor rehabilitation program. Musculoskeletal disorders were common, and the majority of patients were discharged home once the program was completed.

Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19.

Objectives: To explore the characteristics of hallucinations in hospitalized rehabilitation patients with COVID-19. Design: Retrospective review using medical records of patients with COVID-19 and admitted to the acute inpatient rehabilitation unit (ARU). Setting: A public hospital in southern California, specializing in rehabilitation medicine. Participants: Patients with COVID-19 and hallucinations who were consecutively admitted from January 1st to April 30th, 2021. Interventions: Not applicable. Main Outcome Measures: Types and themes of hallucinations. Results: Eight of the 37 patients (21.6%) admitted to the ARU with COVID-19 exhibited hallucinations. All were Hispanic and 7 of them were men; their average age was 56.5 (range: 38-71). Seven patients had COVID-19 pneumonia and 1 developed respiratory distress secondary to Guillain-Barre Syndrome. One patient had posterior reversible encephalopathy syndrome. The average length of stay in the intensive care unit (ICU) was 31.3 days (range: 8-48). Most of the hallucinations occurred during their ICU stay and 2 continued to their ARU stay. All recalled details of hallucinations with 7 exhibiting visual hallucinations, consistent with peduncular hallucinosis with or without auditory and/or tactile components. One patient experienced tactile hallucinations. The themes of hallucinations identified to reflect the contents of the hallucinations were patients' comfort-seeking, fearfulness, and seeing deceased family members. All patients had impaired cognition at the ARU admission but improved at discharge. Four patients had depressed mood/anxiety and 1 had depressed mood alone but without a history of psychiatric illness. ICU delirium was documented in 5 patients. The negative experience of hallucinations seemed to affect their participation of the ARU stay. Conclusions: More than 20% of patients with COVID-19 who were transferred to attend inpatient rehabilitation exhibited hallucinations. It remains uncertain if these hallucinations were related to the SARS-CoV-2 infection. Multidisciplinary rehabilitation team should be aware to support patients with COVID-19 who experience hallucinations.

Association of Functional Characteristics and Physiotherapy with COVID-19 Mortality in Intensive Care Unit in Inpatients with Cardiovascular Diseases.

Background and Objectives: To estimate the association between admission functional outcomes and exposure to physiotherapy interventions with mortality rate in intensive care unit (ICU) inpatients with cardiovascular diseases and new coronavirus disease (COVID-19). Materials and Methods: Retrospective cohort including 100 ICU inpatients (mean (standard deviation), age 75 (16) years) split into COVID-19+ or COVID-19-. The association of in-ICU death with admission functional outcomes and physiotherapy interventions was investigated using univariable and multivariable regression models. Results: In total, 42 (42%) patients tested positive for COVID-19. In-ICU mortality rate was 37%, being higher for the COVID-19+ group (odds ratio, OR (95% CI): 3.15 (1.37-7.47), p = 0.008). In-ICU death was associated with lower admission ICU Mobility Scale score (0.81 (0.71-0.91), p = 0.001). Restricted mobility (24.90 (6.77-161.94), p < 0.001) and passive kinesiotherapy (30.67 (9.49-139.52), p < 0.001) were associated with in-ICU death, whereas active kinesiotherapy (0.13 (0.05-0.32), p < 0.001), standing (0.12 (0.05-0.30), p < 0.001), or walking (0.10 (0.03-0.27), p < 0.001) were associated with in-ICU discharge. Conclusions: In-ICU mortality was higher for inpatients with cardiovascular diseases who had COVID-19+, were exposed to invasive mechanical ventilation, or presented with low admission mobility scores. Restricted mobility or passive kinesiotherapy were associated with in-ICU death, whereas active mobilizations (kinesiotherapy, standing, or walking) were associated with in-ICU discharge in this population.

“EACH ZOOM MEETING MAKES US HAPPY”: VIDEO CONFERENCING EXPERIENCES OF FAMILY MEMBERS OF INDIVIDUALS WITH SEVERE BRAIN INJURY UNDERGOING INPATIENT REHABILITATION DURING THE COVID-19 PANDEMIC

Family involvement is recognised as an important part of the rehabilitation process for individuals suffering from brain injuries. However, in an attempt to prevent the spread of COVID-19, healthcare institutions were obligated to implement visitor restrictions. The aim of this study was to understand the experiences of family members with respect to communication based on video calls with their close relatives who were suffering from brain injuries and undergoing inpatient rehabilitation during the pandemic. We included a purposive sample of 11 participants/family members who communicated consistently with their loved ones via video conferencing as part of the occupational therapy intervention. Qualitative data was collected using a semi-structured interview. Two independent researchers performed a thematic analysis based on the data inquiry method and highlighted three main themes: (1) coping with a traumatic brain injury of a family member, (2) video conferencing experiences with a family member during rehabilitation, and (3) family resilience factors. Our study highlighted that there were changes in the daily lives of the family, as well as that family members had a strong emotional response due to the traumatic event and the inability to stay with the affected individuals in the hospital. Interactions via video conferencing proved to be significant for the participants since it provided them with an insight into the health condition of their family members, enabled their involvement in the rehabilitation process, and allowed them to monitor the recovery process. The above-mentioned factors also contributed to the resilience of participants. Our findings indicate the benefits of virtual communication and involving family members in the rehabilitation process, especially in situations where hospital visitation is impossible. © 2022, University of Zagreb, Faculty of Mining, Geology and Petroleum Engineering. All rights reserved.

Interdisciplinary Management for the First Patient With Post-COVID Double-Lung Transplantation in Inpatient Rehabilitation in the United States: A Case Report.

OBJECTIVE: In the setting of the COVID-19 pandemic, lung transplantation is being used as a life-saving treatment. This case report describes the rehabilitation course of the first documented individual in the United States post bilateral lung transplant for COVID-19. METHODS (CASE DESCRIPTION): The patient is a 28-year-old woman who was previously healthy and who failed all other life-saving medical interventions before undergoing bilateral lung transplantation, resulting in an extended hospital stay and significant physical debility. RESULTS: Through an interdisciplinary rehabilitation approach, the patient was able to achieve functional improvements in strength, balance, endurance, and functional mobility to safely discharge home. CONCLUSION: Research is needed regarding optimal treatment of this patient population because lung transplantation continues to be used for long-term medical management of COVID-19 infection. IMPACT: This is a case report describing rehabilitation for the first documented individual in the United States post bilateral lung transplant for COVID-19.

Guillain-Barré Syndrome Related and Unrelated to COVID-19: Clinical Follow-Up in the COVID-19 Era.

OBJECTIVE: COVID-19 has been associated with neurological complications such as Guillain-Barre syndrome (GBS). Several cases have been reported but without functional outcome data after intensive rehabilitation and medium-term follow-up. METHODS: In this observational study, patients were admitted in 2019 and 2020 to inpatient rehabilitation for GBS and were examined using the Barthel index, GBS-Disability Scale, and Medical Research Scale-sum score at admission, discharge, and at least 6 months after onset of symptoms. All the participants received personalized, goal-oriented inpatient rehabilitative treatment for the recovery of self-sufficiency in everyday life. RESULTS: Eleven people with GBS-3 cases related to COVID-19-were admitted in 2019 and 2020 to inpatient rehabilitation. Eight patients with GBS not related to COVID-19 experienced a high complication rate during inpatient rehabilitation, with 2 deaths due to sepsis. In this cohort, a higher prevalence than expected of acute motor axonal neuropathy was also detected. The COVID-19-related GBS group did not have any complications. After a mean of 10.11 months (SD = 4.46 months), 55.55% of patients regained autonomous walking. CONCLUSION: COVID-19-related GBS appeared to have a better clinical outcome than GBS that was not COVID-19 related. A higher than usual prevalence of acute motor axonal neuropathy form was encountered. More follow-up studies are needed to understand whether the recovery of GBS related to COVID-19 might be different from that of GBS unrelated to COVID-19. IMPACT: No data are currently available on the follow-up of GBS in the COVID-19 era and on the functional outcome of those patients. This study provides important information indicating that GBS related to COVID-19 might have a better clinical outcome than GBS unrelated to COVID-19.

rehabilitation of Patients with severe Disability after coVID-19 in rehabilitation Department. Multiple case study

the COVID-19 pandemic has significantly affected all aspects of life around the world including both the medical system as a whole and individual medical specialties. Understandably, medical rehabilitation was forced to adapt to the new disease, to develop adequate algorithms and technologies that can increase the level of independence and quality of life being disrupted as a result of coronavirus infection. Aim. to analyze, organize and present the results of in-patient rehabilitation of patients after severe forms of COVID-19 infection by reporting the real cases from the clinical practice. Material and methods. COVID-19 infection is a multi-systemic disease, which, in many cases requires for inpatient multidisciplinary rehabilitation program. patients after severe forms of infection suffer different symptoms in variable combinations. According to main disabling signs we can classify all our patients in 3 groups: (1) general weakness or deconditioning, (2) respiratory disorders due to lung disease, and (3) patients with different neurological complications. patients in all groups demonstrate serious psychological compliances which indefinitely have negative influence on rehabilitation process. the paper presents clinical cases specific to each of the groups. results. All hospitalized patients showed good functional improvement through quite standard length of stay in the department All patients were discharged home with the opportunity to return to relatively normal daily activities. Conclusion. patients after severe COVID-19 infection require professional multidisciplinary in-patient rehabilitation. All of them demonstrate good functional improvement and, after quite short period of hospitalization, can be discharged home. © 2018 Kyokai Joho Imeji Zasshi/Journal of the Institute of Image Information and Television Engineers. All rights reserved.

Rehabilitative management of post-acute COVID-19: clinical pictures and outcomes.

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O2) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m2. The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities.

Effectiveness of a Three-Week Inpatient Pulmonary Rehabilitation Program for Patients after COVID-19: A Prospective Observational Study.

For COVID-19 patients who remain symptomatic after the acute phase, pulmonary rehabilitation (PR) is recommended. However, only a few studies have investigated the effectiveness of PR, especially considering the duration between the acute phase of COVID-19 and the onset of rehabilitation, as well as the initial severity. This prospective observational study evaluated the efficacy of PR in patients after COVID-19. A total of 120 still-symptomatic patients referred for PR after overcoming acute COVID-19 were asked to participate, of whom 108 (mean age 55.6 ± 10.1 years, 45.4% female) consented. The patients were assigned to three groups according to the time of referral and initial disease severity (severe acute; severe after interval; mild after interval). The primary outcome was dyspnea. Secondary outcomes included other respiratory disease symptoms, physical capacity, lung function, fatigue, quality of life (QoL), depression, and anxiety. Furthermore, patients rated the overall effectiveness of PR and their subjective change in health status. At the end of PR, we detected improvements with large effect sizes in exertional dyspnea, physical capacity, QoL, fatigue, and depression in the overall group. Other parameters changed with small to medium effect sizes. PR was effective after acute COVID-19 in all three groups analyzed.

Use of virtual reality in the inpatient rehabilitation of COVID-19 patients.

INTRODUCTION: Use of virtual reality (VR) in healthcare has expanded in recent years. The challenges faced by patients with prolonged COVID-19-related hospitalizations - social isolation, disability, neurologic sequelae, adjustment-related anxiety, depression, and stress - may be mitigated by the novel use of VR as one modality of a comprehensive rehabilitation plan. This descriptive study aimed to understand patient satisfaction and perceived benefit of virtual reality on a COVID-19 recovery unit, as well as the logistical and operational feasibility of providing VR content for patients and staff. MATERIALS AND METHODS: During the COVID-19 surge in New York City in 2020, the COVID-19 Recovery Unit (CRU) of a large academic hospital invited patients and staff to participate in VR sessions with three categories of experience: (1) Guided meditation, (2) Exploration of natural environments, (3) Cognitive stimulation games. Patients and staff were surveyed about satisfaction and perceived benefit. RESULTS: 13 patients and 11 staff were surveyed, with median patient satisfaction scores of 9 out of 10, with ten representing "extremely satisfied," and median staff satisfaction scores of 10. 13/13 patients answered "yes" to recommending the therapy to others, and 12/13 answered "yes" to perceived enhancement of their treatment. 11/11 staff answered "yes" to recommending the therapy to others, and 11/11 answered "yes" to perceived enhancement of their wellbeing. DISCUSSION: A VR program implemented on a COVID-19 rehabilitation unit for patients and healthcare providers was rated as highly satisfactory with perceived benefit by survey respondents. Participants commented that the use of VR was useful in coping with isolation and loneliness, and could be implemented within the context of clinical care for COVID-19 patients as part of a comprehensive rehabilitation model. The use of VR was also logistically and operationally feasible on the CRU. Future work to compare benefits of VR to standard neuropsychological rehabilitation is needed.

Characteristics and outcomes of COVID-19-Positive Individuals Admitted for Inpatient Rehabilitation in Toronto, Canada.

OBJECTIVE: To describe the sociodemographic features, impairments, and functional changes of COVID-19-positive individuals who underwent inpatient rehabilitation at three rehabilitation hospitals in Toronto, Canada. DESIGN: Retrospective chart review of patients admitted to three COVID-19 rehabilitation units between 20 April 2020 and 3 June 2020. Sociodemographic factors, impairments, length of stay, and Functional Independence Measure data were reported. RESULTS: A total of 41 patients were included in this study, including 22 males and 19 females. The median age was 75 years. Thirty-six percent of patients were admitted to the intensive care unit during their acute stay. The most commonly affected body functions were: neuromusculoskeletal (73.2%); combined cardiovascular, haematological, immunological, and respiratory (65.9%); and mental functions (29.3%). Median total Functional Independence Measure score was 85 at admission and 108.5 at discharge. CONCLUSION: This study represents some of the first data on the characteristics and outcomes of COVID-19-positive individuals admitted to inpatient rehabilitation in Toronto, Canada early in the COVID-19 pandemic.

Inpatient Virtual Vision Clinic Improves Access to Vision Rehabilitation Before and During the COVID-19 Pandemic.

OBJECTIVE: To describe and evaluate a secure video call system combined with a suite of iPad vision testing apps to improve access to vision rehabilitation assessment for inpatients. DESIGN: Retrospective. SETTING: Two acute care inpatient rehabilitation hospitals and 1 long-term acute care (LTAC) hospital. PARTICIPANTS: Records of inpatients seen by the vision service. INTERVENTIONS: Records from a 1-year telemedicine pilot performed at acute rehabilitation (AR) hospital 1 and then expanded to AR hospital 2 and LTAC hospital during coronavirus disease 2019 (COVID-19) were reviewed. In the virtual visits, an occupational therapist measured the patients' vision with the iPad applications and forwarded results to the off-site Doctor of Optometry (OD) for review prior to a video visit. The OD provided diagnosis and education, press-on prism application supervision, strategies and modifications, and follow-up recommendations. Providers completed the telehealth usability questionnaire (10-point scale). MAIN OUTCOME MEASURES: Vision examinations per month at AR hospital 1 before and with telemedicine. RESULTS: With telemedicine at AR hospital 1, mean visits per month significantly increased from 10.7±5 to 14.9±5 (P=.002). Prism was trialed in 40% of cases of which 83% were successful, similar to previously reported in-person success rates. COVID-19 caused only a marginal decrease in visits per month (P=.08) at AR1, whereas the site without an established program (AR hospital 2) had a 3-4 week gap in care while the program was initiated. Cases at the LTAC hospital tended to be more complex and difficult to manage virtually. The telehealth usability questionnaire median category scores were 7 for Ease of Use, 8 for Interface Quality, 6 for Reliability, and 9 for Satisfaction and Future Use. CONCLUSIONS: The virtual vision clinic process improved inpatient access to eye and visual neurorehabilitation assessment before and during the COVID-19 quarantine and was well accepted by providers and patients.

COVID-19 issues related to pediatric neuropsychology and inpatient rehabilitation - challenges to usual care and solutions during the pandemic.

Objective: To describe the challenges related to COVID-19 affecting pediatric neuropsychologists practicing in inpatient brain injury rehabilitation settings, and offer solutions focused on face-to-face care and telehealth.Methods: A group of pediatric neuropsychologists from 12 pediatric rehabilitation units in North America and 2 in South America have met regularly since COVID-19 stay-at-home orders were initiated in many parts of the world. This group discussed challenges to clinical care and collaboratively problem-solvedsolutions.Results: Three primary challenges to usual care were identified, these include difficulty providing 1) neurobehavioral and cognitive assessments; 2) psychoeducation for caregivers and rapport building; and 3) return to academic instruction and home. Solutions during the pandemic for the first two areas focus on the varying service provision models that include 1) face-to-face care with personal protective equipment (PPE) and social distancing and 2) provision of care via remote methods, with a focus on telehealth. During the pandemic,neuropsychologists generally combine components of both the face-to-face and remote care models. Solutions to the final challenge focus on issues specific to returning to academic instruction and home after an inpatient stay.Conclusions: By considering components of in-person and telehealth models of patient care during the pandemic, neuropsychologists successfully serve patients within the rehabilitation setting, as well as the patient's family who may be limited in their ability to be physically present due to childcare, illness, work-related demands, or hospital restrictions.

Considerations for Postacute Rehabilitation for Survivors of COVID-19.

Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question "What rehabilitation services do survivors of COVID-19 require?" The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible.