Dependency Towards Independence: The Inpatient Rehabilitation of Severe Critical Illness Polyneuropathy Resulting as a Rare Complication of COVID-19

ABSTRACT

Case Diagnosis A 50-year-old man developed severe critical illness polyneuropathy, and other severe medical complications, as a rare complication of COVID-19 which required extensive and an unusually long inpatient rehabilitation Case Description or Program Description This is an unusual case of a 50-year-old man who developed severe critical illness polyneuropathy (CIP) after COVID-19 infection. His acute care stay was notable for respiratory failure, cardiac arrest, pressure sore, and quadriparesis. Diagnostic evaluation was consistent with CIP. He was transferred to a long term acute care hospital (LTACH) for medical care, wound care, pulmonary management and rehabilitation, dependent for all self care and mobility upon admission. His rehabilitation started upon admission to the LTACH. He ultimately fully engaged an interdisciplinary team approach which incorporated specialized technology such as a robotic powered exoskeleton. His length of stay at the LTACH was 10 months, while the average length of stay in LTACH's is approximately 1 month. By the end of his unusually prolonged inpatient stay, he was ambulatory with bilateral ankle foot orthosis and a walker. Setting(s) LTACH Assessment/Results: Upon discharge, he was ambulatory with bilateral ankle foot orthosis, a walker, and was discharged home. Discussion (relevance) The COVID 19 challenges include medical complications, neurologic sequelasuch as CIP, the average length of stays of inpatient care, and insurance approval of inpatient care. A successful strategy for those profoundly impacted requires a comprehensive view of the challenges, engagement of an interdisciplinary team, and powerful patient advocacy. Conclusion(s) This case highlights the importance of recognizing the challenges of COVID 19 infection, reviews interventions in the context of patient's functional goals, reviews the unusually long length of stay that may be required, reviews the advocacy needed to ensure patient access to inpatient rehabilitation, and reviews the literature.