Impact of the COVID-19 Pandemic on the Level of Anxiety and Depression in Caregivers of Children Benefiting from Neurorehabilitation Services.

INTRODUCTION: At the turn of March and April 2020, due to the occurrence of COVID-19 in Poland, the first restrictions on the provision of rehabilitation services were introduced. Nevertheless, caregivers strived to ensure that their children could benefit from rehabilitation services. AIM OF THE STUDY: To determine which of the selected data presented in the media reflecting the intensity of the COVID-19 epidemic in Poland differentiated the level of anxiety and depression in caregivers of children benefiting from neurorehabilitation services. MATERIAL AND METHODS: The study group consisted of caregivers of children (n = 454) receiving various neurorehabilitation services in the inpatient ward of Neurological Rehabilitation of Children and Adolescents (n = 200, 44%), in the Neurorehabilitation Day Ward (n = 168, 37%), and in the Outpatient Clinic (n = 86, 19%) of the Clinical Regional Rehabilitation and Education Center in Rzeszow. The average age of the respondents was 37.23 ± 7.14 years. The Hospital Anxiety and Depression Scale (HADS) was used to measure the severity of anxiety and depression in caregivers of children. The questionnaires were distributed from June 2020 to April 2021. As a measure of the severity of the COVID-19 epidemic in Poland, the figures presented in the media were adopted. In addition, data on the COVID-19 pandemic presented in the media (Wikipedia, TVP Info, Polsat Nes, Radio Zet) on the day preceding the completion of the survey were analyzed based on statistical analysis methods. RESULTS: 73 of the surveyed caregivers (16.08%) suffered from severe anxiety disorders, and 21 (4.63%) from severe depressive disorders. The average severity of anxiety (HADS) in the subjects was 6.37 points, and the average severity of depression was 4.09 points. There was no statistically significant relationship between the data presented in the media-such as daily number of infections, total number of infections, daily number of deaths, total number of deaths, total number of recoveries, number of hospitalizations, and people under quarantine-and the level of anxiety and depression of the studied caregivers (p > 0.05). CONCLUSIONS: It was not found that the selected data presented in the media, showing the intensity of the COVID-19 epidemic in Poland, significantly differentiated the level of anxiety and depression among caregivers of children using neurorehabilitation services. Their motivation to continue the treatment, caused by concern for their children's health, resulted in less severe symptoms of anxiety and depression during the peak period of the COVID-19 pandemic.

Neurorehabilitation in time of COVID 19: A perspective from Pakistan.

A global public health emergency, the coronovirus disease-2019 pandemic has impacted every way of life, including neuro-rehabilitation, worldwide. Issues related to increased service demand in primary care, exhausted or insufficient healthcare facilities were significantly high in low and middle-income countries, like Pakistan, with already a struggling health infrastructure. This required major change in health service delivery and impacted rehabilitation care of vulnerable patients with neurological conditions and impairments. For the current review, relevant key words and their combinations were used for literature search, including 'COVID 19', 'SARS-CoV-2', 'Corona Virus', 'rehabilitation', 'physical rehabilitation', 'pandemic', 'NCOC', 'lockdown', 'health services', 'physical therapy', 'disability', 'access', 'tele-rehabilitation', 'research', 'human resource', 'healthcare', etc. The platforms searched were Google search, Google Scholar and PubMed. The idea was to highlight how the pandemic impacted neuro-rehabilitation care in countries like Pakistan throughout the pandemic duration and during the lockdowns.

Reaching a Tipping Point for Neurorehabilitation Research: Obstacles and Opportunities in Trial Design, Description, and Pooled Analysis.

The record-breaking pace of COVID-19 vaccine development and implementation depended heavily on collaboration among academic, government, and commercial stakeholders, especially through data-sharing and robust multicenter trials. Collaborative efforts have not been as fruitful in fields such as neurorehabilitation, where non-pharmacological interventions play a much larger role. Barriers to translating scientific advancements into clinical practice in neurorehabilitation include pervasively small study sizes, exacerbated by limited funding for non-pharmacological multicenter clinical trials; difficulty standardizing-and adequately describing-non-pharmacological interventions; and a lack of incentives for individual patient-level data-sharing. These barriers prevent reliable meta-analysis of non-pharmacological clinical studies in neurorehabilitation. This point-of-view will highlight these challenges as well as suggest practical steps that may be taken to improve the neurorehabilitation pipeline between evidence and implementation.

Changes in neurorehabilitation management during the COVID-19 pandemic: A scoping review.

BACKGROUND: The SARS-CoV-2 infection (COVID-19) has generated a threat to global health, determining the need for healthcare for large numbers of people in an extremely short timeOBJECTIVE:To investigate the management changes in the neurorehabilitation services during the COVID-19 pandemic. METHODS: An electronic search was conducted in September 2021 by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews. All studies on organizational and welfare changes resulting from the COVID-19 pandemic in neurorehabilitation services were included. Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. RESULTS: The summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.Electronic searches after the screening of title and abstract identified 80 studies, 13 studies met the inclusion criteria. A narrative summary of results of all included studies were reported in a tabular format. CONCLUSIONS: Different organizational models were adopted in neurorehabilitation during the COVID-19 pandemic impacting the therapies time frame, the physical and mental health of healthcare professionals and the caregiver's workload. There is still uncertainty about the effectiveness of these new therapeutic strategies on the management of neurorehabilitation services and future studies should explore the effect on the patients' needs.

Neurocognitive Rehabilitation in COVID-19 Patients: A Clinical Review.

Abstract: COVID-19 has affected many people all around the world for more than two years now have suffered many long-term consequences which is commonly referred to as long-haulers. Despite multiorgan complaints in long haulers, symptoms related to cognitive functions commonly referred as brain fog are seen in the high risk covid patients with age more than 50, women more than men, obesity, asthma and those who experienced more than five symptoms during the first week of covid illness. Long term isolation has certainly contributed to high level of anxiety and stress calling for an empathetic response to this group of covid patients as there is no specific test to detect long haulers and no specific cognitive rehabilitation techniques available as of today.

[Evaluation of the impact of lockdown on the health and lifestyle of users of the Fundacio Esclerosi Multiple's neurorehabilitation centres in Lleida and Reus]. / Evaluación del impacto del confinamiento sobre la salud y el estilo de vida de las personas usuarias de los centros neurorrehabilitadores de Lleida y Reus de la Fundació Esclerosi Múltiple.

INTRODUCTION: On 13 March 2020, a state of alarm was declared due to the COVID-19 pandemic, resulting in total lockdown in Spain. The neurorehabilitation centres of the Fundacio Esclerosi Multiple (FEM) provide care for people diagnosed with neuroprogressive diseases with significant health deficits. We look at how lockdown can affect their way of life. AIMS: To assess and manage the impact of lockdown on persons with multiple sclerosis (MS) and other neurodegenerative diseases. PATIENTS AND METHODS: Analytical observational study. An anonymous questionnaire was administered to all the patients undergoing comprehensive rehabilitation treatment at two of the FEM centres; the survey included questions on the demographic and clinical characteristics of the subjects, and an assessment of the impact of the pandemic on the physical, social and psychological spheres. RESULTS: A total of 202 surveys were analysed. The average age of the participants was 49.09 years and 77.8% had MS, while 22.2% had other conditions. The most frequently reported physical symptoms were muscle weakness, loss of balance and fatigue. The study population remained active during lockdown. More than half of them did not report any increase in cognitive symptoms, but they did mention an increased sense of worry on an emotional level. CONCLUSIONS: We can state that the actions deployed by the FEM to reduce the consequences of lockdown have been effective and have minimised the occurrence of maladaptive behaviours. The study has also opened the door for us to add new lines of intervention.

TITLE: Evaluación del impacto del confinamiento sobre la salud y el estilo de vida de las personas usuarias de los centros neurorrehabilitadores de Lleida y Reus de la Fundació Esclerosi Múltiple.Introducción. El día 13 de marzo de 2020 se decretó el estado de alarma con motivo de la pandemia de la COVID-19, lo que supuso un confinamiento domiciliario total en España. Los centros neurorrehabilitadores de la Fundació Esclerosi Múltiple (FEM) atienden a personas diagnosticadas de enfermedades neuroprogresivas con déficits de salud importantes. Analizamos cómo el confinamiento puede afectar a su forma de vida. Objetivos. Evaluar y gestionar el impacto del confinamiento en la persona con esclerosis múltiple (EM) y otras enfermedades neurodegenerativas. Pacientes y métodos. Estudio observacional analítico. Se aplicó un cuestionario anónimo a todas las personas que estaban en tratamiento rehabilitador integral en dos de los centros de la FEM, que incluía características demográficas y clínicas de los sujetos, junto con la evaluación del impacto de la pandemia en la esfera física, social y psicológica. Resultados. Se han analizado un total de 202 encuestas. La edad media de los participantes ha sido de 49,09 años. Un 77,8% presenta EM, mientras que un 22,2% tiene otras patologías. Los síntomas físicos que han aparecido más frecuentemente han sido debilidad muscular, pérdida de equilibrio y fatiga. La población estudiada se ha mantenido activa durante el confinamiento. Más de la mitad no refiere aumento en los síntomas cognitivos, pero sí que aparece, a nivel emocional, un aumento de la sensación de preocupación. Conclusiones. Podemos afirmar que las acciones desplegadas desde la FEM, para reducir las consecuencias del confinamiento, han sido efectivas y han bajado al máximo la aparición de conductas desadaptativas. El estudio también nos ha abierto la puerta a añadir nuevas líneas de intervención.

Clinical applications and consideration of interventions of electrotherapy for orthopedic and neurological rehabilitation.

Electrotherapy or electrical stimulation (ES) is a part of clinical intervention in the rehabilitation field. With rehabilitation intervention, electrotherapy may be provided as a treatment for pain relief, strengthening, muscle education, wound recovery, or functional training. Although these interventions may not be considered as the primary therapy for patients, the advantages of the ease of operation, lower costs, and lower risks render ES to be applied frequently in clinics. There have also been emerging ES tools for brain modulation in the past decade. ES interventions are not only considered analgesics but also as an important assistive therapy for motor improvement in orthopedic and neurological rehabilitation. In addition, during the coronavirus disease pandemic, lockdowns and self-quarantine policies have led to the discontinuation of orthopedic and neurological rehabilitation interventions. Therefore, the feasibility and effectiveness of home-based electrotherapy may provide opportunities for the prevention of deterioration or extension of the original therapy. The most common at-home applications in previous studies showed positive effects on pain relief, functional ES, muscle establishment, and motor training. Currently, there is a lack of certain products for at-home brain modulation; however, transcranial direct current stimulation has shown the potential of future home-based rehabilitation due to its relatively small and simple design. We have organized the features and applications of ES tools and expect the future potential of remote therapy during the viral pandemic.

Early Neurorehabilitation and Recovery from Disorders of Consciousness After Severe COVID-19.

BACKGROUND: Early neurorehabilitation improves outcomes in patients with disorders of consciousness (DoC) after brain injury, but its applicability in COVID-19 is unknown. We describe our experience implementing an early neurorehabilitation protocol for patients with COVID-19-associated DoC in the intensive care unit (ICU) and evaluate factors associated with recovery. METHODS: During the initial COVID-19 surge in New York City between March 10 and May 20, 2020, faced with a disproportionately high number of ICU patients with prolonged unresponsiveness, we developed and implemented an early neurorehabilitation protocol, applying standard practices from brain injury rehabilitation care to the ICU setting. Twenty-one patients with delayed recovery of consciousness after severe COVID-19 participated in a pilot early neurorehabilitation program that included serial Coma Recovery Scale-Revised (CRS-R) assessments, multimodal treatment, and access to clinicians specializing in brain injury medicine. We retrospectively compared clinical features of patients who did and did not recover to the minimally conscious state (MCS) or better, defined as a CRS-R total score (TS) ≥ 8, before discharge. We additionally examined factors associated with best CRS-R TS, last CRS-R TS, hospital length of stay, and time on mechanical ventilation. RESULTS: Patients underwent CRS-R assessments a median of six (interquartile range [IQR] 3-10) times before discharge, beginning a median of 48 days (IQR 40-55) from admission. Twelve (57%) patients recovered to MCS after a median of 8 days (IQR 2-14) off continuous sedation; they had lower body mass index (p = 0.009), lower peak serum C-reactive protein levels (p = 0.023), higher minimum arterial partial pressure of oxygen (p = 0.028), and earlier fentanyl discontinuation (p = 0.018). CRS-R scores fluctuated over time, and the best CRS-R TS was significantly higher than the last CRS-R TS (median 8 [IQR 5-23] vs. 5 [IQR 3-18], p = 0.002). Earlier fentanyl (p = 0.001) and neuromuscular blockade (p = 0.015) discontinuation correlated with a higher last CRS-R TS. CONCLUSIONS: More than half of our cohort of patients with prolonged unresponsiveness following severe COVID-19 recovered to MCS or better before hospital discharge, achieving a clinical benchmark known to have relatively favorable long-term prognostic implications in DoC of other etiologies. Hypoxia, systemic inflammation, sedation, and neuromuscular blockade may impact diagnostic assessment and prognosis, and fluctuations in level of consciousness make serial assessments essential. Early neurorehabilitation of these patients in the ICU can be accomplished but is associated with unique challenges. Further research should evaluate factors associated with longer-term neurologic recovery and benefits of early rehabilitation in patients with severe COVID-19.

Online Dance Therapy for People With Parkinson's Disease: Feasibility and Impact on Consumer Engagement.

BACKGROUND: Therapeutic dancing can be beneficial for people living with Parkinson's disease (PD), yet community-based classes can be difficult to access. OBJECTIVE: To evaluate the feasibility and impact of online therapeutic dancing classes for people in the early to mid-stages of PD. METHODS: Co-produced with people living with PD, physiotherapists, dance teachers and the local PD association, the 'ParkinDANCE' program was adapted to enable online delivery during the COVID-19 pandemic. Participants completed 8 one-hour sessions of online therapeutic dancing. Each person was assigned their own dance teacher and together they selected music for the classes. A mixed-methods design enabled analysis of feasibility and impact. Feasibility was quantified by attendance and adverse events. Impact was determined from individual narratives pertaining to consumer experiences and engagement, analysed with qualitative methods through a phenomenological lens. RESULTS: Attendance was high, with people attending 100% sessions. There were no adverse events. Impact was illustrated by the key themes from the in-depth interviews: (i) a sense of achievement, enjoyment and mastery occurred with online dance; (ii) project co-design facilitated participant engagement; (iii) dance instructor capabilities, knowledge and skills facilitated positive outcomes; (iv) music choices were key; and (v) participants were able to quickly adapt to online delivery with support and resources. CONCLUSIONS: Online dance therapy was safe, feasible and perceived to be of benefit in this sample of early adopters. During the pandemic, it was a viable form of structured physical activity. For the future, online dance may afford benefits to health, well-being and social engagement.

Speech-language pathology approaches to neurorehabilitation in acute care during COVID-19: Capitalizing on neuroplasticity.

Neurologic manifestations associated with a coronavirus disease 2019 (COVID-19) diagnosis are common and often occur in severe and critically ill patients. In these patients, the neurologic symptoms are confounded by critical care conditions, such as acute respiratory distress syndrome (ARDS). Patients with dual diagnoses of COVID-19 and neurologic changes such as myopathy, polyneuropathy, and stroke are likely at a higher risk of experiencing deficits with swallowing, communication, and/or cognition. Speech-language pathologists are an integral part of both the critical care and neurologic disorders multi-disciplinary teams, offering valuable contributions in the evaluation, treatment, and management of these areas. Patients in intensive care units (ICUs) who require mechanical ventilation often experience difficulty with communication and benefit from early speech-language pathology intervention to identify the most efficient communication methods with the medical team and caregivers. Moreover, patients with neurologic manifestations may present with cognitive-linguistic impairments such as aphasia, thereby increasing the need for communication-based interventions. Difficulties with voice and swallowing after extubation are common, often requiring frequent treatment sessions, possibly persisting beyond ICU discharge. After leaving the ICU, patients with COVID-19 often experience physical, cognitive, and mental health impairments collectively called post-intensive care syndrome. This is often a lengthy road as they progress toward full recovery, requiring continued speech-language pathology treatment after hospital discharge, capitalizing on the principles of neuroplasticity.

The Impact of the COVID-19 Pandemic on Traumatic Brain Injury Management: Lessons Learned Over the First Year.

The COVID-19 pandemic has had widespread consequences on health care systems around the world. It resulted in extensive changes to the referral patterns, management, and rehabilitation of surgical conditions. We aimed to evaluate the effect the COVID-19 pandemic has had on traumatic brain injury (TBI) specifically. We reviewed the literature published on COVID-19 and TBI referrals, management, and rehabilitation. Significant changes were seen in the referral patterns of TBIs worldwide, explained by changes in societal behaviors and changes in the mechanism of injury. Implementation of strict infection control measures and COVID-19 screening was commonplace, with some reporting changes to operating room protocols. TBI was more likely to be conservatively managed. Rehabilitation services were restricted, with a greater shift towards telemedicine to provide rehabilitative therapy remotely.

Guillain-Barré syndrome associated with COVID-19 infection: a case from the UK.

Originating from Wuhan, China, COVID-19 has rapidly spread worldwide. Neurological manifestations are more commonly associated with severe COVID-19 infection. Guillain-Barré syndrome (GBS) is a rare immune-mediated postinfectious neuropathy. It has been reported as a possible rare complication of COVID-19. We report a case of GBS associated with COVID-19 in the UK.

[Weaning in neurological and neurosurgical early rehabilitation-Results from the "WennFrüh" study of the German Society for Neurorehabilitation]. / Weaning in der neurologisch-neurochirurgischen Frührehabilitation ­ Ergebnisse der "WennFrüh"-Studie der Deutschen Gesellschaft für Neurorehabilitation.

Neurological and neurosurgical early rehabilitation patients are often so critically ill that they must be weaned from mechanical ventilation in addition to early rehabilitative treatment. The German Society for Neurorehabilitation (DGNR) carried out a survey and asked neurological weaning units to provide information on structural characteristics of the facility, including personnel and technical resources and the number of cases and outcome based on anonymous data. In total 36 weaning units from 11 federal states with a total of 496 beds participated in the survey. From 2516 weaning cases documented in 2019, 2097 (83.3%) could primarily be successfully weaned from mechanical ventilation and only 120 (4.8%) had to be discharged with home ventilation. The mortality in this sample was 11.0% (n = 276). The results of the survey demonstrate that prolonged weaning during early neurological and neurosurgical rehabilitation is an important and effective component of healthcare provision for critically ill patients in Germany.

COVID-19 and spinal cord injury and disease: results of an international survey as the pandemic progresses.

STUDY DESIGN: An online survey. OBJECTIVES: To follow-up with and re-query the international spinal cord community's response to the Coronavirus Disease 2019 (COVID-19) pandemic by revisiting questions posed in a previous survey and investigating new lines of inquiry. SETTING: An international collaboration of authors and participants. METHODS: Two identical surveys (one in English and one in Spanish) were distributed via the internet. Responses from both surveys were pooled and analyzed for demographic and response data. RESULTS: Three hundred and sixty-six respondents were gathered from multiple continents and regions. The majority (63.1%) were rehabilitation physicians and only 12.1% had patients with spinal cord injury/disease (SCI/D) that they knew had COVID-19. Participants reported that the COVID-19 pandemic had caused limited access to clinician and support services and worsening medical complications. Nearly 40% of inpatient clinicians reported that "some or all" of their facilities' beds were being used by medical and surgical patients, rather than by individuals requiring inpatient rehabilitation. Respondents reported a 25.1% increase in use of telemedicine during the pandemic (35% used it before; 60.1% during), though over 60% felt the technology incompletely met their patients' needs. CONCLUSION: The COVID-19 pandemic has negatively impacted the ability of individuals with SCI/D to obtain their "usual level of care." Moving forward into a potential "second wave" of COVID-19, patient advocacy and efforts to secure access to thorough and accessible care are essential.