All Media
All Media

Neurorehabilitation of COVID-19

Categories: Professionals

By David Salisbury, Psy.D., ABPP-CN, Pate Rehabilitation

As we are nearly two years into the COVID-19 pandemic, we are learning more about how SARS-CoV-2 and its variants impact the central nervous system. This opportunist virus has a range of presentations with increased risk for neurological, physical, emotional, and cognitive problems particularly among individuals who are older and have more medical comorbidities. With my admitted healthcare provider fatigue partly related to the politicized media surrounding the pandemic resulting in suboptimal management of populations healthcare needs, this brief article opts to present a few opportunities in brain injury care that may arise from this pandemic.

We are in midst of a pandemic that has the potential to build awareness of brain injury simply based on the prevalence of individuals impacted directly or indirectly. Recent estimates from the World Health Organization COVID-19 dashboard suggest about 252 million COVID-19 cases globally and about 47 million alone in the United States. While numbers have varied across studies related to mild versus more severe presentation, about 5% of individuals may experience complications severe enough to need ICU-level care. Neurological complications tend to be much more common in this subgroup as well. Increased risk of acquired brain injury related to stroke, anoxia, encephalopathies, seizures, and various other presentations have been detailed.  More research is needed to better understand the growing reports of longer-term problems for individuals with milder and even asymptomatic cases. Overall though, these daunting numbers suggest that a considerable group of individuals will experience post-COVID cognitive, physical, and emotional changes that could benefit from treatment. The frequently experienced problems that being found across studies include many rehabilitation targets that are mainstays in brain injury rehabilitation services including:

  • Addressing physical deconditioning, weakness, balance, and gait impairment
  • Fatigue management
  • Pain and headache management
  • Strategies to address cognitive changes (i.e., slower speed of thinking, poor attention, memory problems)
  • Interventions targeting psychological changes (i.e., depression, anxiety, post-traumatic stress disorder, sleep disruption)

The surge of neurorehabilitation needs is already leading to studies to understand best practices for post-COVID-19 care. There is strong support that the longstanding holistic model often used in brain injury care is very applicable for this group given the various cardiac, respiratory, neurological, psychiatric, and other sequala from COVID-19. An approach integrating medical, physical, cognitive, and emotional recovery is needed in many cases. The mantra of early and more intense rehabilitation for COVID-19 acquired brain injury also appears to be warranted based on our clinical experience to date.  For decades, advocates of brain injury care have consistently touted the need to focus on the less visible aspects of acquired brain injury which can be even more impactful on quality of life. We can expect this message to be highlighted in the years to come with the subgroup of COVID-19 survivors that have residual symptoms. Ideally, this will help our society better understand the full range of care needs after all forms and severities of brain injury.

The pandemic has been a key catalyst in making telehealth mainstream. If advocacy groups are successful in securing ongoing funding for telehealth services and subsequent allowance for reimbursement of virtual services, the brain injury community should benefit from greater access to specialized care across facility to home settings. Transportation challenges, geography barriers, and limited access to professionals trained in brain injury care have historically hindered survivors from receiving the needed initial and life-long care to maximize outcomes. With permanent reimbursement for telephonic and video-based rehabilitation therapies, access to care could be expanded which would be a long-overdue victory.   

Advocacy for acquired brain injury will need to include support for the vast number of individuals who may experience residual cognitive, physical, and emotional changes following COVID-19. We can only hope that the lessons we have learned regarding the “hidden” challenges that have been well documented over decades of brain injury research are used to best understand and help those who have been adversely impacted by COVID-19. The brain injury community can be integral as a strong voice focused on a societal goal of flattening the looming rehabilitation pandemic. Our focus on supporting the continued need for specialized COVID-19 rehabilitation programs and maintenance of telehealth options will be pivotal in addressing access to care issues for this growing subpopulation in the brain injury community.

Additional Resources

References

About The Author

David Salisbury, Psy.D., ABPP-CN is a board-certified neuropsychologist who serves as the Director of Clinical Operations for Pate Rehabilitation which provides post-acute brain injury rehabilitation throughout the Dallas-Ft. Worth Metroplex.