Tele-rehabilitation in Spinal Cord Injury (SCI) in India: An Essential but Uphill Task.

The number of spinal cord injury (SCI) patients is gradually increasing in India. But due to the unavailability of rehabilitation facilities at the grass root level and most of the patient's financial status, institution-based SCI rehabilitation is still not feasible for many of SCI patients. Tele-rehabilitation can help to rehabilitate the SCI patients to a satisfactory extent where providing hospital-based rehabilitation is not possible. During the COVID-19 pandemic, tele-rehabilitation showed its true potential already. Poverty, lack of education, and lack of technical knowledge of the patients can be a major barrier to its implication. However, with the government's support, suitable manpower, and will to serve, we can deliver tele-rehabilitation services for SCI patients in the remotest and poorest areas of India.

Adhesive Capsulitis After COVID-19 Vaccination: A Case Series.

ABSTRACT: Of the many bizarre complications of administration of the COVID 19 vaccine, adhesive capsulitis is almost unheard of, although shoulder injury related to vaccine administration, which by definition has symptom onset within 48 hrs and is caused by faulty injection technique, has been rarely reported. Nine cases of adhesive capsulitis, five males and four females with a mean age of 48.7 ± 12.7 yrs, presenting within 1 mo of intramuscular Covishield vaccine on the ipsilateral deltoid and fulfilling the standard UK FROST Multicenter Study diagnostic criteria are reported. The mean time interval from vaccination until symptom onset was 12.3 ± 3.1 days, and mean symptom duration was 9.4 ± 2.4 wks. Conventional treatment with nonsteroidal anti-inflammatory drugs, followed by intra-articular steroid injection coupled with suprascapular nerve steroid block, improved the pain score and range of movement in 8 wks. The exact pathogenesis remains an enigma, although mechanisms such as local spread via deltoid muscle microvasculature, nerves, or shoulder injury related to vaccine administration causing secondary adhesive capsulitis have been hypothesized. While adhesive capsulitis is a very common diagnosis in the physiatric outpatient setting, the possible association with Covishield vaccination, the Indian version of the Oxford AstraZeneca recombinant ChAdOx1 nCoV-19 vaccine, is almost absent in existing literature and hence likely to be missed by clinicians, which necessitates this report.

Factors Associated With Persistence of Dyspnea and Change in Health-Related Quality of Life in Patients With COVID-19 After Discharge.

Introduction Coronavirus disease 2019 (COVID-19) is a deadly virus affecting multiple organ systems, predominantly the respiratory system. Dyspnea along with the deterioration of health-related quality of life (HRQoL) is common in COVID-19 patients discharged from a dedicated Coronavirus disease (COVID) hospital. Very few studies in India used HRQoL for the assessment of COVID-19 patients after discharge. Our article aims to assess the factors associated with the persistence of dyspnea and HRQoL in discharged patients of COVID-19. Methods A total of 48 patients were included in this prospective observational study. Ethical approval from Institutional Ethics Committee was obtained before the enrolment of patients. Patients having dyspnea at exertion and during discharge were selected for this study. Modified Medical Research Council (mMRC) scale and modified Borg scale were used for assessing dyspnea on activity, and Saint George's Respiratory Questionnaire (SGRQ) was used to assess HRQoL. Data were collected on the day of discharge (D0) and after 60 days (D60) post-discharge. The significance of changes in parameters from D0 to D60 was evaluated by paired t-test. Results The mean mMRC, modified Borg, and SGRQ scores at D0 were 2.38±0.98, 3.15±2.12, and 45.36±27.32, respectively, which were improved to 0.94±0.86, 0.94±1.27, and 19.22±18.96 at D60. Age showed significant positive correlations with initial modified Borg (r=0.292, p=0.044) and SGRQ (r=0.332, p=0.021) scores. Body mass index showed significant positive correlations with initial mMRC (r=0.352, p=0.014) and SGRQ (r=0.419, p=0.003) scores. Conclusion Our study showed that on discharge, many COVID patients have impaired HRQoL. Many of them also have dyspnea on exertion. With the early institution of standard pulmonary rehabilitation protocol, symptoms and HRQoL improves rapidly in a month. Different influencing factors were identified. Long-term follow-up with a bigger sample size is needed to formulate a management strategy for these patients.

Rehabilitation in Coronavirus Disease 2019 positive post-partum haemolysis, elevated liver enzymes and low platelet count syndrome

Haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome is a rare condition associated with cerebrovascular accidents. It usually happens in the third trimester, although it can also present in the early weeks of pregnancy or the postpartum period. A 24-year-old female presented with 39 weeks of gestation. After 2 days of delivery, she developed generalised convulsions and following that she had burst abdomen with sepsis. She was diagnosed with a case of HELLP syndrome. After that she became coronavirus disease 2019 (COVID-19) positive and was shifted to a COVID-intensive care unit (ICU) where she was provided ventilator support. After 3 months of ICU stay, she was shifted to the rehabilitation unit. In the meantime, she had an episode of stroke with associated quadriparesis, impaired cognition, loss of vision, dysphagia and bladder-bowel involvement. Rehabilitation outcome was partially successful in her case. Post-partum HELLP syndrome associated with COVID-19 can develop severe complications. Medical management combined with goal-oriented customised rehabilitation can lead to a better outcome.

Post coronavirus disease-2019 vaccination Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating disorder of the peripheral nerve. Different variants of GBS can produce a wide array of symptoms among which motor weakness, areflexia without bladder-bowel involvement are commonly encountered. ChAdOx1 nCoV-19 is a recombinant Corona Virus Vaccine and it is incorporated into India's coronavirus disease-2019 (COVID-19) vaccination program. Few rare instances of serious neurological complications have been reported following COVID-19 vaccination. Our case received 2 dose of COVID-19 vaccine. After receiving 1st dose he had rapid onset of ascending paralysis without any sensory and bladder bowel involvement. He received Intra Venous Immuno Globulin and Injection prednisolone for 5 days. Following that his lower limb weakness resolved rapidly but there was no improvement in upper limb weakness. Nerve conduction study showed demyelinating etiology and along with clinical features, it was appeared to be a case of GBS. However, more evidence is needed before establishing the causal relationship between COVID-19 vaccines and GBS.