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1.
Physiol Rep ; 10(16): e15391, 2022 08.
Article in English | MEDLINE | ID: covidwho-1994596

ABSTRACT

The acute phase of COVID-19 has been well studied, however with increasing post-acute COVID-19 syndrome, much is unknown about its long-term effects. A common symptom in both the acute and post-acute phases has been fatigue, assessed predominantly qualitatively. Here we present a case study objectively assessing neuromuscular fatiguability in a young male (27 year, 1.85 m, 78 kg) who continues to experience COVID-19 related fatigue and cognitive dysfunction, including other symptoms, 12+ months post-infection. Prior to infection, he was part of a neuromuscular study forming the basis of our pre-COVID-19 results. The study was repeated 12 months post-COVID-19 infection. Muscle strength, endurance, torque steadiness, voluntary activation, twitch properties, electromyography, and compound muscle action potential were obtained and compared pre- and post-COVID-19. All measurements were done using a dorsiflexion dynamometer in which the participant also was asked to produce a one-minute fatiguing maximal voluntary contraction. Muscle strength, voluntary activation, and fatigability (slope of torque) showed no meaningful differences, suggesting intrinsic neuromuscular properties are not affected. However, torque steadiness was impaired three-fold in the post- compared with pre-COVID-19 test. The participant also reported a higher level of perceived exertion subjectively and a continued complaint of fatigue. These findings indicate that muscle fatiguability in post-acute COVID-19 syndrome may not be a limitation of the muscle and its activation, but a perceptual disconnect caused by cognitive impairments relating to physical efforts. This case report suggests the potential value of larger studies designed to assess these features in post-acute COVID-19 syndrome.


Subject(s)
COVID-19 , Isometric Contraction , COVID-19/complications , Electromyography/methods , Fatigue/etiology , Humans , Isometric Contraction/physiology , Male , Muscle Contraction/physiology , Muscle Fatigue/physiology , Muscle, Skeletal/physiology , Muscles , Torque
3.
Ann Otol Rhinol Laryngol ; 131(9): 1032-1035, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1467790

ABSTRACT

OBJECTIVE: Evidence demonstrates neurotropism is a common feature of coronaviruses. In our laryngology clinics we have noted an increase in cases of "idiopathic" vocal fold paralysis and paresis in patients with no history of intubation who are recovering from the novel SARS-Cov-2 coronavirus (COVID-19). This finding is concerning for a post-viral vagal neuropathy (PVVN) as a result of infection with COVID-19. Our objective is to raise the possibility that vocal fold paresis may be an additional neuropathic sequela of infection with COVID-19. METHODS: Retrospective review of patients who tested positive for COVID-19, had no history of intubation as a result of their infection, and subsequently presented with vocal fold paresis between May 2020 and January 2021. Charts were reviewed for demographic information, confirmation of COVID-19 infection, presenting symptoms, laryngoscopy and stroboscopy exam findings, and laryngeal electromyography (LEMG) results. RESULTS: Sixteen patients presented with new-onset dysphonia during and after recovering from a COVID-19 infection and were found to have unilateral or bilateral vocal fold paresis or paralysis. LEMG was performed in 25% of patients and confirmed the diagnosis of neuropathy in these cases. CONCLUSIONS: We believe that COVID-19 can cause a PVVN resulting in abnormal vocal fold mobility. This diagnosis should be included in the constellation of morbidities that can result from COVID-19 as the otolaryngologist can identify this entity through careful history and examination.


Subject(s)
COVID-19 , Paresis , Vocal Cord Paralysis , COVID-19/complications , Electromyography/methods , Humans , Paresis/diagnosis , Paresis/etiology , SARS-CoV-2 , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/etiology , Vocal Cords/pathology
4.
BMJ Case Rep ; 13(10)2020 Oct 29.
Article in English | MEDLINE | ID: covidwho-1304206

ABSTRACT

We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. A 54-year-old woman developed neurological symptoms after SARS-CoV-2 infection. We tested for various antiganglioside antibodies, that had not been investigated in previous cases. The patient was diagnosed with GBS based on neurological and electrophysiological findings; no antiganglioside antibodies were detected. In previous reports, most patients with SARS-CoV-2-infection-related GBS had lower limb predominant symptoms, and antiganglioside antibody tests were negative. Our findings support the notion that non-immune abnormalities such as hyperinflammation following cytokine storms and microvascular disorders due to vascular endothelial damage may lead to neurological symptoms in patients with SARS-CoV-2 infection. Our case further highlights the need for careful diagnosis in suspected cases of GBS associated with SARS-CoV-2 infection.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , COVID-19 , Electromyography/methods , Female , Guillain-Barre Syndrome/therapy , Humans , Hypesthesia/diagnosis , Hypesthesia/etiology , Japan , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Pandemics/prevention & control , Pandemics/statistics & numerical data , Rare Diseases , Risk Assessment , Severity of Illness Index , Treatment Outcome
5.
J Speech Lang Hear Res ; 63(10): 3293-3310, 2020 10 16.
Article in English | MEDLINE | ID: covidwho-982521

ABSTRACT

Purpose Surface electromyography (sEMG) is often used for biofeedback during swallowing rehabilitation. However, commercially available sEMG electrodes are not optimized for the head and neck area, have rigid form, and are mostly available in large medical centers. We developed an ultrathin, soft, and flexible sEMG patch, specifically designed to conform to the submental anatomy and which will be ultimately incorporated into a telehealth system. To validate this first-generation sEMG patch, we compared its safety, efficiency, and signal quality in monitoring submental muscle activity with that of widely used conventional sEMG electrodes. Method A randomized crossover design was used to compare the experimental sEMG patch with conventional (snap-on) sEMG electrodes. Participants completed the same experimental protocol with both electrodes in counterbalanced order. Swallow trials included five trials of 5- and 10-ml water. Comparisons were made on (a) signal-related factors: signal-to-noise ratio (SNR), baseline amplitude, normalized mean amplitude, and sEMG burst duration and (b) safety/preclinical factors: safety/adverse effects, efficiency of electrode placement, and satisfaction/comfort. Noninferiority and equivalence tests were used to examine signal-related factors. Paired t tests and descriptive statistics were used to examine safety/preclinical factors. Results Forty healthy adults participated (24 women, M age = 67.5 years). Signal-related factors: SNR of the experimental patch was not inferior to the SNR of the conventional electrodes (p < .0056). Similarly, baseline amplitude obtained with the experimental patch was not inferior to that obtained with conventional electrodes (p < .0001). Finally, normalized amplitude values were equivalent across swallows (5 ml: p < .025; 10 ml: p < .0012), and sEMG burst duration was also equivalent (5 ml: p < .0001; 10 ml: p < .0001). Safety/preclinical factors: The experimental patch resulted in fewer mild adverse effects. Participant satisfaction was higher with the experimental patch (p = .0476, d = 0.226). Conclusions Our new wearable sEMG patch is equivalent with widely used conventional sEMG electrodes in terms of technical performance. In addition, our patch is safe, and healthy older adults are satisfied with it. With lessons learned from the current COVID-19 pandemic, efforts to develop optimal swallowing telerehabilitation devices are more urgent than ever. Upon further validation, this new technology has the potential to improve rehabilitation and telerehabilitation efforts for patients with dysphagia. Supplemental Material https://doi.org/10.23641/asha.12915509.


Subject(s)
Deglutition Disorders/rehabilitation , Electrodes , Electromyography/instrumentation , Telerehabilitation/instrumentation , Wearable Electronic Devices , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections , Cross-Over Studies , Deglutition/physiology , Electromyography/methods , Equipment Design , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral , SARS-CoV-2
6.
Clin Neurophysiol ; 131(12): 2809-2816, 2020 12.
Article in English | MEDLINE | ID: covidwho-898641

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has a high incidence of intensive care admittance due to the severe acute respiratory syndrome (SARS). Intensive care unit (ICU)-acquired weakness (ICUAW) is a common complication of ICU patients consisting of symmetric and generalised weakness. The aim of this study was to determine the presence of myopathy, neuropathy or both in ICU patients affected by COVID-19 and whether ICUAW associated with COVID-19 differs from other aetiologies. METHODS: Twelve SARS CoV-2 positive patients referred with the suspicion of critical illness myopathy (CIM) or polyneuropathy (CIP) were included between March and May 2020. Nerve conduction and concentric needle electromyography were performed in all patients while admitted to the hospital. Muscle biopsies were obtained in three patients. RESULTS: Four patients presented signs of a sensory-motor axonal polyneuropathy and seven patients showed signs of myopathy. One muscle biopsy showed scattered necrotic and regenerative fibres without inflammatory signs. The other two biopsies showed non-specific myopathic findings. CONCLUSIONS: We have not found any distinctive features in the studies of the ICU patients affected by SARS-CoV-2 infection. SIGNIFICANCE: Further studies are needed to determine whether COVID-19-related CIM/CIP has different features from other aetiologies. Neurophysiological studies are essential in the diagnosis of these patients.


Subject(s)
COVID-19/complications , Intensive Care Units , Muscular Diseases/etiology , Polyneuropathies/etiology , SARS-CoV-2 , Aged , Biopsy , Critical Illness , Electromyography/methods , Female , Humans , Male , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Muscle Weakness/pathology , Muscle, Skeletal/pathology , Muscular Diseases/diagnosis , Muscular Diseases/pathology , Muscular Diseases/physiopathology , Neural Conduction , Polyneuropathies/diagnosis , Polyneuropathies/physiopathology
8.
Can J Neurol Sci ; 48(1): 25-30, 2021 01.
Article in English | MEDLINE | ID: covidwho-722070

ABSTRACT

The COVID-19 pandemic has had a major impact on clinical practice. Safe standards of practice are essential to protect health care workers while still allowing them to provide good care. The Canadian Society of Clinical Neurophysiologists, the Canadian Association of Electroneurophysiology Technologists, the Association of Electromyography Technologists of Canada, the Board of Registration of Electromyography Technologists of Canada, and the Canadian Board of Registration of Electroencephalograph Technologists have combined to review current published literature about safe practices for neurophysiology laboratories. Herein, we present the results of our review and provide our expert opinion regarding the safe practice of neurophysiology during the COVID-19 pandemic in Canada.


Subject(s)
COVID-19/prevention & control , Electroencephalography/methods , Electromyography/methods , Neural Conduction , Canada , Deep Brain Stimulation , Diagnostic Techniques, Neurological , Electrodiagnosis/methods , Humans , Infection Control/methods , Patient Isolators , Personal Protective Equipment , Physical Distancing , SARS-CoV-2 , Triage/methods , Vagus Nerve Stimulation
9.
Brain Stimul ; 13(5): 1453-1460, 2020.
Article in English | MEDLINE | ID: covidwho-704141

ABSTRACT

BACKGROUND: Neuroimaging technology is being developed to enable non-invasive mapping of the latency distribution of cortical projection pathways in white matter, and correlative clinical neurophysiological techniques would be valuable for mutual verification. Interhemispheric interaction through the corpus callosum can be measured with interhemispheric facilitation and inhibition using transcranial magnetic stimulation. OBJECTIVE: To develop a method for determining the latency distribution of the transcallosal fibers with transcranial magnetic stimulation. METHODS: We measured the precise time courses of interhemispheric facilitation and inhibition with a conditioning-test paired-pulse magnetic stimulation paradigm. The conditioning stimulus was applied to the right primary motor cortex and the test stimulus was applied to the left primary motor cortex. The interstimulus interval was set at 0.1 ms resolution. The proportions of transcallosal fibers with different conduction velocities were calculated by measuring the changes in magnitudes of interhemispheric facilitation and inhibition with interstimulus interval. RESULTS: Both interhemispheric facilitation and inhibition increased with increment in interstimulus interval. The magnitude of interhemispheric facilitation was correlated with that of interhemispheric inhibition. The latency distribution of transcallosal fibers measured with interhemispheric facilitation was also correlated with that measured with interhemispheric inhibition. CONCLUSIONS: The data can be interpreted as latency distribution of transcallosal fibers. Interhemispheric interaction measured with transcranial magnetic stimulation is a promising technique to determine the latency distribution of the transcallosal fibers. Similar techniques could be developed for other cortical pathways.


Subject(s)
Corpus Callosum/physiology , Electromyography/methods , Evoked Potentials, Motor/physiology , Motor Cortex/physiology , Transcranial Magnetic Stimulation/methods , Adolescent , Adult , Female , Functional Laterality/physiology , Humans , Inhibition, Psychological , Male , Neural Inhibition/physiology , Young Adult
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