Acute inpatient rehabilitation of two post-covid presentations: A case series

Abstract

BACKGROUND AND PURPOSE: The rehabilitation of post-intensive care syndrome and critical illness myopathy has been well documented.1,2 However, the recent wave of individuals recovering from COVID-19 demonstrate unique treatment considerations based on their presentation. While there is some research regarding acute care for post-COVID patients, there is a need for information later in the recovery process.3Most of those in the post-acute phase have cardiopulmonary complications, but there is increased evidence of neurological and orthopedic components.4 This case series aims to discuss the physical therapy treatment of two post-COVID patients based on NYU's categorizations 'debility with COVID-19,' or 'neurological with COVID-19' and highlight their differences.5 CASE DESCRIPTION: Two subjects admitted to an acute inpatient rehabilitation (AIR) facility after hospital stay of 42 (subject A) and 64 days (subject B), due to COVID- 19. The latter being longer due to development of a lacunar stroke. Both are male with an average age of 54.5 years. Each received symptom specific physical therapy 2-3hrs, 6-7 days/week. Subject A received cardiopulmonary therapy, nightly CPAP, standard balance and strengthening exercises. Limitations were O2 desaturation and orthostatic hypotension. Patient B received functional strengthening, balance and blocked motor control exercises to promote neural plasticity. AIR length of stay was 17 days for patient A and 28 days for patient B. OUTCOMES: Outcome measures included the Berg Balance Score (BBS), 6 min walk test, and 10m walk test. O2 saturation levels and heart rate were monitored with activity. For patient A, BBS improved by 19 points, 6 min walk improved by more than 100ft, limited primarily by O2 desaturation. No significant change in gait speed was made, but he transitioned from rolling walker to cane. For patient B, BBS improved by 36 points, 6 min walk improved by over 800ft, and gait speed by .32 m/s. Patient B received a right ankle-foot orthotic and required a rolling walker. Neither subject required O2 at discharge. Patient A was at an independent level, but had decreased cardiovascular endurance and activity tolerance. Patient B was largely independent but required intermittent supervision with some higher level activities, primarily due to motor control deficits. DISCUSSION: By the end of their inpatient rehabilitation stay, both patients made statistically significant improvements in all measured outcomes. This suggests while a primary focus will be on treatment of pulmonary impairments, there should also be adjustments made based on their individual presentation of COVID and neuromuscular deficits. In conclusion, the outcomes of this case series demonstrate the efficacy of treating post-COVID patients with variable presentations in the acute inpatient rehabilitation physical therapy setting.