Supplementary Table I: Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Update as of August 31st, 2020
Author DOI Year Country Dates Aim of the study Study Design Type of rehabilitation service Research Question LFRI COVID-19 Phases Population N° of participants Clinical presentation Intervention Comparator Outcomes Adverse events Diagnostic test Sensitivity Specifity Types of validity Attributes of reliability Main findings
Abdulsalam MA 10.1111/ane.13321 2020 Kuwait N/A To report a case of generalized status epilepticus as a possible initial manifestation of COVID-19 Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 1 Continuous tonic-clonic seizures Intubated and mechanically ventilated,Intravenous diazepam but was ineffective, Intravenous midazolam N/A N/A N/A N/A N/A N/A N/A N/A This is a case of a 32-year-old male who presented generalized status epilepticus without a prior history of seizure or epilepsy as a possible initial manifestation of COVID-19 infection. He had no other symptoms of COVID-19.
  • After midazolam the convulsions were aborted and he extubated after 36 hours.
  • CT scan of the brain showed no lesion, Cerebrospinal fluid revealed an elevated protein level with normal glucose.
  • About fourteen days later, he was discharged in stable condition, remaining afebrile and asymptomatic.
  • The pathogenesis of this manifestation may be multifactorial, as the result of both the neurotropism of SARS-CoV-2 in addition to blood-brain barrier breakdown precipitated by proinflammatory cytokine reactions.
Akram A 10.7759/cureus.9320 2020 Pakistan N/A To describe the case of an elderly patient with preexisting IPF and laboratory-confirmed SARS-CoV- 2, who presented acutely with rapid progression to septic shock Descriptive: Case Report N/A Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Idiopathic Pulmonary Fibrosis developing COVID-19 1 high fever, hypotension, confusion, lethargy, tachypnea, bilateral crackles hydroxychloroquine 400 mg × BD, IV azithromycin 400 mg × OD, IV solu cortef 100 mg × TDS, heparin, IV fluids and a norepinephrine infusion. N/A N/A N/A N/A N/A N/A N/A N/A This case reports an acute COVID-19 infection in a elderly patient with IPF.
  • At admission, the patient was confused, lethargic, dyspneic with high fever and low blood pressure and a room air SpO2 of 90%
  • Laboratory exams showed leukopenia, lymphocytopenia, altered coagulation and liver function studies
  • On the night following admission his status deteriorated and the patient died by septic shock
The author concluded that IPF patients are at high risk of SARS-CoV-2 pneumonia with more severe manifestations. These patients should take extra precautions to avoid exposure to SARS-CoV-2.
Avci A 10.1007/s13365-020-00888-3 2020 Turkey N/A To report a case of subarachnoid hemorrhage developing in patient with Covid-19-related pneumonia Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 1 Subarachnoid hemorrhage with impaired consciousness N/A N/A N/A N/A N/A N/A N/A N/A N/A A 50-year-old male with no concomitant disease was admitted to the emergency department due to impaired consciousness: lung imaging suggested COVID-19-associated pneumonia and cerebral tomography revealed subarachnoidal hemorrhage. The patient was hospitalized in ICU and died on the 83rd day due to COVID-19-associated pneumonia. In the presence of an anamnesis suggesting respiratory system infection such as cough and weakness in patients who come with sudden loss of consciousness, performing lung imaging as well as the performing brain computerized tomography can allow detection of an underlying Covid-19 infection.
Bagnato S 10.1016/j.ijid.2020.07.072 2020 Italy From March to June, 2020 To describe neurophysiological findings from a patient who developed critical illness myopathy after a long stay in ICU for COVID-19 Descriptive: Case Report General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 1 Diffuse and symmetrical muscle weakness (ranging from 3/5 to 4/5 on MRC) 68 days post COVID-19 onset. Deep tendon reflexes reduced in lower limb. The patient walked a few steps with assistance. Rehabilitation program 3 h/day for 6 days/week for 2 months N/A N/A N/A N/A N/A N/A N/A N/A The patient had a critical illness myopathy confirmed by NCS/EMG/DMS. She underwent a rehabilitation treatment for 2 months with almost complete motor recovery. Given a large number of patients with COVID-19 who require long ICU stays, many are very likely to develop this condition in the coming months. Since rehabilitation programs can be effective, health systems must plan to provide adequate access to rehabilitative facilities for both pulmonary and motor rehabilitative treatment after COVID-19.
Basi S 10.1136/bcr-2020-235920 2020 UK April 2020 To describe a case report of a 66-year- old man with an acute ischaemic stroke in the setting of a COVID-19 infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 At the admission the patient showed a left-sided weakness, an incresed musle tone in his left upper limb, a mild left facial droop, and a deterioration in his speech pattern. Moreover, he required 2 L of nasal cannula oxygen to maintain his oxygen saturations between 88% and 92%. Then, his respiratory condition worsened and his levels of consciousness reduced. The patient was pronounced dead by doctors at four days after the admission. Nasal cannula oxygen at 2 L and then Venturi mask at 8 L of oxygen; intravenous and ciprofloxacin; 300 mg of aspirin N/A N/A N/A N/A N/A N/A N/A N/A A 66 yrs old patient admitted with diagnosis of right frontal cerebral infarct had a concomitant COVID-19 pneumonia. In his clinical history he had atrial fibrillation and had one previous ischaemic stroke, with a consequent left-sided haemiparesis, that had completely resolved. His worsening respiratory condition and reduced levels of consciousness, present during the LOS, made it impossible to assess progression of the neurological deficit after stroke. His comatose condition persisted throughout the admission. The patient was pronounced dead by doctors at four days after the admission.
Belli S 10.1183/13993003.02096-2020 2020 Italy N/A To assess the proportion of COVID-19 patients with low physical functioning and/or impaired performance of ADLs at the time of discharge. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 115 N/A N/A N/A - 1-minute sit-to-stand test - Short Physical performance Battery - Barthel Index N/A N/A N/A N/A N/A N/A 103 of 115 patients hospitalized for COVID-19 survived and were discharged at home
  • During the stay 9 patients received non-invasive ventilation and 12 mechanical ventilation and NIV
  • At discharge:
    • The patients were discharged home after a mean stay of 16.1 (7.4) days, with a length of stay shorter for the mechanically ventilated group: 11.1 (3.4) versus 16.8 (7.6) days
    • 33.3% of patients had a number of 1 minute sit-to-stand repetitions below percentile 2.5
      • 53.3% had low and 17.5% moderaty SPPB summary scores
    • 47.5% had a poor score on the Barthel index (<= 60)17.5% were still bedridden 21% needed O2-supplementation- COVID-19 patients discharged home after hospitalisation in an acute and subsequent post-acute ward, have a clear need for rehabilitative interventions
Benger M 10.1016/j.bbi.2020.06.005 2020 UK From 1st February 2020 to 14th May 2020 To provide a description of clinical, radiological and laboratory characteristics of consecutive patients presenting to King’s College Hospital (KCH) with ICH in association with COVID-19 Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 5 Case 1:
  • 41 years old male with well controlled hypertension and type 2 diabetes with 8 days history of cough, fever and fatigue who needed intubation 24 hours post-admission
  • one day after extubation: drowsiness and right-sided hemiplegia
Case 2:
  • 54 years old female well controlled hypertension and type 2 diabetes presenting with a 2-weeks history of cough, and 12-hours history of sudden onset dysarthria and left-sided hemiparesis
Case 3:
  • 55 years old male with well controlled hypertension presenting with a 3-weeks history of cough, pleuritic chest pain and shortness of breath and severe hypoxia
Case 4:
  • 64 years old female with a six-day history of cough, shortness of breath and fever requiring immediate intubation and ventilation for multiple organ failure (respiratory, cardiac and renal), the patient
  • Four weeks post-admission, low GCS post-sedation wean
Case 5:
  • A 52 years old male with a history of ischaemic heart disease, quiescent untreated multiple sclerosis, asthma, hypertension and hyperlipidaemia, presented with a two-week history of shortness of breath, cough, fevers and pleuritic chest pain
  • Three days post-admission: deterioration of respiratory function
  • Three weeks later: ongoing low GCS after sedation wean
 Case 1:
  • mechanical ventilation
  • prophylactic dose of low molecular weight heparin
Case 2:
  • prothrombin complex concentrate and vitamin K
Case 3:
  • immediate intubation and ventilation
  • treatment for multiple organ failure (lung, cardiac, renal and liver)
  • prophylactic dose of LMWH
Case 4:
  • immediate intubation and ventilation
  • treatment for multiple organ failure (respiratory, cardiac and renal)
  • prophylactic dose of LMWH
Case 5:
  • intubation and ventilation
  • cardiac, respiratory, and renal support
  • intravenous heparin later switched to a prophylactic dose of LMWH
 N/A N/A N/A N/A N/A N/A N/A N/A 5 relatively young patients with COVID-19 suffered from ICH with a mean age lower than expected for ICH
  • 4 patients had lobar ICHs and all of them had a pre-existing hypertension
  • The delay between the onset of COVID-19 symptoms and time of ICH diagnosis had a median of 32 days and during that period all patients had evidence of a prolonged inflammation with multiple organ failure in four out of five patients
  • patients 1 and 2 were discharged to rehabilitation centres while the other patients remained in ICU requiring multiple organ support
Albeit a causal relationship between ICH and COVID-19 remains to be confirmed, this study provides the first evidence for a younger patient demographic, a lobar predominance, and a long systemic inflammatory prodrome. It also highlights two challenges:
  • treating the thrombotic consequences of COVID-19
  • diagnosing ICH in heavily-sedated ICU patients
Bolaji P 10.1136/bcr-2020-236820 2020 UK N/A To report a COVID-19 case with extensive cerebral venous sinus thrombosis with bilateral venous cortical infarcts and acute cortical haemorrhage Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 with CVST 1 Left-sided weakness, left-sided sensory inattention, and subsequent focal seizures, then status epilepticus and coma Anticoagulation and antiepileptic, intubation, then inpatient rehabilitation N/A N/A N/A N/A N/A N/A N/A N/A This case reports of a 63 yrs old man a potential association between CVST and COVID-19 infection.
  • COVID-19 may cause venous thromboembolism either through increased cytokine and clotting factors production or direct endothelial injury through binding to the ACE2 receptor.
  • CVST is associated with a good functional outcome despite the severity of neurological deficit if it is diagnosed and treated early with anticoagulation and complications like status epilepticus are addressed.
Chakraborty U 10.1136/bcr-2020-238668 2020 India N/R To report a case of acute transverse myelitis associated with COVID-19 infection in a 59-year-old female Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 Acute-onset progressive ascending flaccid paraplegia, retention of urine, constipation, and fever. No lower limbs deep tendon reflexes, a sensory level at T10 segment. After injectable steroids she did show some signs of recovery. A day later, she developed an acute- onset respiratory failure, a sudden cardiac arrest and she died despite resuscitation maneuvers. Corticosteroids N/A N/A N/A N/A N/A N/A N/A N/A Considering the onset of ATM symptoms in the background of a confirmed COVID-19 test and initial improvement with steroids, ATM may be considered as an immune-mediated response to the virus. It is rare but it has severe consequences and early identification is very important to initiate appropriate treatment.
Cunha P 10.1111/ene.14474 2020 France N/A To describe a new type of delayed onset movement disorders in five patients who were admitted to ICUs for severe SARS-CoV-2 infection Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Sensory functions and pain b2) Post-acute COVID-19 5 Upper limbs postural and action-tremor was observed in 4 patients,
  • Patient 2 had also irregular orthostatic tremor
  • Patient 4 had bilateral upper limbs jerky/myoclonic abnormal movements at rest and during posture and action
  • Associated signs included a moderate proximal motor deficit in 4 patients and a mild hemiparesis in one patient.
 - in ICU: intubation and ventilation N/A N/A N/A N/A N/A N/A N/A N/A
  • 5 COVID-19 patients developed abnormal movements 23 ± 7 days (mean + SD) after ICU discharge
  • MRI performed in all patients showed microbleeds in 4 patients and a bilateral frontotemporal hypoperfusion in one patient
D'Andrea S 10.1038/s41394-020-0319-0 2020 Italy April 2020 To evaluate differences in clinical features and evolution of COVID-19 between people with SCI and able-bodied individuals Descriptive: Historical cohort Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition SCI patients developing COVID-19 15 Out of 15 SCI-patients affected by COVID-19, 10 (66.7%) were symptomatic, 10 (66.7%) with fever, 9 (60.0%) with dry cough, 3 (20.0%) had dyspnea, 2 (13.4%) with diarrhea, 1 (6.7%) had anosmia, and 2 (13.4%) had fatigue. All individuals who tested positive for SARS-CoV-2 among SCI patients (cases) and able-bodied healthcare workers (controls) were enrolled in a historic cohort study COVID-19 able-bodied controls (n=17) COVID-19 clinical features; COVID-19 radiological findings; COVID-19 treatment; COVID-19 evolution N/A N/A N/A N/A N/A N/A Fever and dry cough were the most common symptoms of COVID-19 without significant differences between SCI patients and able-bodied controls. In conclusion, the authors showed that in their sample SCI patients had a favorable prognosis, not differing from controls. Therefore, the authors hypothesized that it is due to the early COVID-19 diagnosis, with a consequent prompt management; however, future larger studies are necessary to confirm these findings.
Figueiredo R 10.1136/bcr-2020-237146 2020 Portugal N/A To present a case of a term pregnancy diagnosed with COVID-19 after presenting with isolated peripheral facial palsy. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute pregnant woman with COVID-19 1 A 35-year-old woman, primigravida, 39-week gestation, presenting with involuntary drooling with acute peripheral facial palsy
  • 10-day tapering prednisolone course, starting at 60 mg/day
  • Eye hydration measures
  • Facial physiotherapy exercises
 N/A Facial palsy severity N/A N/A N/A N/A N/A N/A
  • This is the case report of a term pregnancy diagnosed with COVID-19 after presenting with isolated peripheral facial palsy
  • Labor ensued normally, with vaginal delivery
  • Tha patient received facial physiotherapy and 15 days after birth neurologic deficits slightly improved
  • Neurological symptoms could be the first and only manifestation of the COVID-19.
Franco C 10.1183/13993003.02130-2020. 2020 Italy From March 1st to May 10th,2020 To analyze the safety of the hospital staff, the feasibility, and outcomes of noninvasive respiratory support applied to patients outside the ICU. Descriptive: Historical cohort General postacute rehabilitation Meso Level Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 670 N/A 163 HFNC, 330 CPAP, 177 NIV N/A Length of stay in hospital, endotracheal intubation and deaths N/A N/A N/A N/A N/A N/A The majority of patients (49.3%) were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9% with 16%, 30%, and 30%, while the total endotracheal intubation rate was 27% with 29%, 25% and 28%, for HFNC, CPAP, and NIV, respectively, and the relative probability to die was not related to the NRS.
  • Endotracheal intubation and length of stay were not different among the groups. The mortality rate increased with age and comorbidity class progression.
  • 42 of 353 (11.4%) health-care workers who had been taking care of patients receiving NRS tested positive for infection, but only 3 required hospitalization.
  • The application of NRS outside the ICU is feasible and associated with favorable outcomes. Nonetheless, it was associated with a risk of staff contamination.
Ghanchi H 10.7759/cureus.9995 2020 USA From March to April, 2020 (intra-COVID period) To assess the impact of COVID-19 on the volume of stroke patients in Colton Institution, California, and also on regional and national levels Analytical: Cross-sectional study N/A Epidemiology - Prevalence N/A N/A Stroke Patients (intra-COVID period) 262 N/A N/A Stroke volumes in pre-COVID period (March and April 2019) and peri-COVID period (January and February 2020) N/A N/A N/A N/A N/A N/A N/A
  • There was a significant increase in last known well time to arrival to the emergency department as well as time from arrival to the emergency department to obtaining a CT of the head in March 2020 compared to 2019.
  • There was a statistically significant decrease in the final diagnosis of TIA at Colton hospital in California, all California hospitals, and all West Regional hospitals during the March-April 2020 window, suggesting that some patients with minor stroke symptoms may not be presenting to the hospital in the midst of the pandemic.
  • Strategies to minimize delays in care and maximize functional recovery must continue to evolve as new challenges are met during the COVID-19 pandemic.
Hajdu SD 10.1161/STROKEAHA.120.030794 2020 International November 2019 - April 2020 To determine the effect on endovascular therapy for patients with acute ischemic stroke during the COVID-19 confinement Descriptive: Historical cohort N/A Epidemiology - Prevalence N/A N/A Stroke Patients (treated with endovascular therapy in the COVID-19 period ) 1600 N/A To compare outcome measures according to the COVID-19 confinement (dates identified for each country varying from March 9, 2020 to March 23, 2020) Patients treated by endovascular therapy for acute ischemic stroke before COVID-19 confinement Mean number of endovascular therapies performed and mean stroke onset-to-groin puncture time interval (minutes) per hospital and per 2-week interval N/A N/A N/A N/A N/A N/A There was a significant decrease in mean number of endovascular therapies performed per hospital per 2-week interval between before and after COVID-19 confinement (9.0 vs 6.1; p<0.001). Moreover, the authors observed a significant increase in mean stroke onset-togroin puncture time between before and after COVID-19 confinement (300.3 vs 354.5 minutes; p<0.001). Less interventions might lead to a higher disability.
Han X 10.1097/PHM.0000000000001535 2020 China From December 30, 2019 to February 17, 2020 To analyze the infection features of inpatients with brain damage in one rehabilitation ward of a large general hospital with natural exposure to COVID-19 at the beginning of the outbreak Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Prevalence Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Brain injury rehabilitation inpatients developing COVID-19 25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 4 of 25 patients (16%) with brain damage admitted to this rehabilitation ward were diagnosed with COVID-19 pneumonia. COVID-19 patients were older (60.5 vs 50), with a higher prevalence rate of tracheotomy (75% vs 9.5%) and underlying pulmonary infection (100% vs 38.1%). Their modified Barthel Index scores were significantly lower than those of noninfected subjects (7.5 ± 9.6 vs 29.5 ± 26.4). Brain damage inpatients with impaired airways and low activity levels are more susceptible to COVID-19 and can easily become severely ill or even die.
Hemphill NM 10.1016/j.cjca.2020.04.038 2020 USA From the beginning of 2020 to April 5th To quantify the change in physical activity observed during the early phase of the COVID-19 pandemic in children with CHD Analytical: Cohort study N/A Epidemiology - Prevalence N/A N/A Children with CHD 109 N/A Physical activity in the first 14 weeks of 2020 Physical activity in the corresponding weeks in 2019 Weekly average step counts N/A N/A N/A N/A N/A N/A This paper compares the physical activity, measured as weekly average step counts, of children with CHD in the first 14 weeks of 2020 and compare it with the same period in 2019: from January through early March (week 1 to 12), 2019 and 2020 step-counts are similar and increasing, while later in March, 2020 step-counts are significantly lower than 2019 (week 13 and 14). Reduced physical activity due to COVID-19 pandemic may have negative impacts on physical, cardiovascular and mental health in children with CHD: long term impact need to be considered.
Hermann M 10.1097/PHM.0000000000001549 2020 Switzerland From March to May, 2020 To characterize COVID-19 patients referred to in- patient rehabilitation and describe performance and outcome during cardiopulmonary rehabilitation. Analytical: Cohort study Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 28 N/A Multimodal 2-4 weeks inpatient CR: 25-30 therapy sessions, 5-6 days per week. CRQ, HADS, CIRS, FIM, 6-MWT, FT N/A N/A N/A N/A N/A N/A The cohort presents patients referred for CR who was divided into mechanically ventilated patients (n=12) or not ventilated patients (n=16) in the acute hospital setting in order to analyze the impact of very severe COVID-19.
  • 50% were female, mean age was 66 years and patients stayed in the acute hospital for 19.3±10.7 days before referral for CR. 17 patients (61%) needed previous ICU treatment.
  • Risk factors, assessments, and questionnaires on admission were comparable in both groups.
  • Significant enhancements were observed in 6-MWT and FT which were independent of previous ventilation status.
  • Comprehensive CR following COVID-19 is safe, feasible, and effective.
Hsueh S-J 10.1016/j.jfma.2020.07.042 2020 Taiwan March to May To report a possible neuromuscular manifestation of SARS-CoV-2 infection Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 with quadriplegia 1 - 51-year-old Taiwanese woman with a history of hypertension and obesity - On admission: dyspnea - Post-extubation: quadriplegia with intact pinprick sensation intact, and mildly decreased vibratory sensation in the ankles - intubation - rosuvastatin, cisatracurium, zithromycin, meropenem, lopinavir/ ritonavir, hydroxychloroquine, baricitinib and sedative agents N/A N/A N/A N/A N/A N/A N/A N/A This is the case report of a middle-aged woman found positive to SARS-CoV-2 after a travel to Europe. Due to progressive dyspnea, she was intubated and on March 15th and extubated on April 9th. The PCR for SARS-CoV-2 became negative since April 6th. The following days she remained quadriplegic with gradual recovery which led her to be able to walk again on May 1st. Laboratory and instrumental exams were compatible with myopathy. Follow-up in late May 2020 revealed full muscle power. Authors suggest that inflammatory myopathy should be considered as a cause for persistent respiratory failure and weakness in patients with COVID-19
Khare J 10.1016/j.dsx.2020.08.012 2020 India N/A To study the effect of lock down on glycemic control in diabetic patients and possible factor responsible for this Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors N/A N/A Adult patients with type 2 diabetes 143 N/A N/A Same population - pre-lock down Fasting Blood Glucose Post Prandial Blood Glucose N/A N/A N/A N/A N/A N/A This study compared assessed the effects of lock-down on blood glucose levels in adults with type 2 diabetes. Both fasting and postprandial blood glucose in lock down period were higher than prior to lock down, statistically significant difference was seen with postprandial blood glucose only. The most common factor worsening of hyperglycemia were:
  1. psychological stress
  2. change in exercise
  3. dietary changes
  4. difficulty in getting medication and medical advice
Lascano AM 10.1111/ene.14368 2020 Switzerland From March to April 2020 To report a series of three cases of typical GBS, preceded by classic signs and symptoms of biologically confirmed COVID-19 Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 3 Distal paresthesias and rapidly progressive limb weakness, evolving to either moderate tetraparesis (2/3) or tetraplegia (1/3) and areflexia (3/3) within the first 5 days. Two patients presented with pain and only one with bulbar signs and facial biplegia. Neurological symptoms appeared within the first 22 days (7, 15 and 22 days) after the appearance of typical COVID-19-related symptoms. Intravenous immunoglobulin N/A N/A N/A N/A N/A N/A N/A N/A Three patients presented a classic demyelinating pattern, occurring 15 (7-22) days after classic signs and symptoms of biologically confirmed COVID-19. All three patients were treated with intravenous immunoglobulin and had a favourable clinical course: one fully recovered and was discharged, another one was able to walk with assistance and the last one remained bedridden but was able to rise to standing up.
Le Guennec L 10.1111/epi.16612 2020 France N/A To report a case of status epilepticus as the first manifestation of COVID-19 Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 At admission: 5-day history of cough, fever, and anosmia One week after admission: verbal perseverations and imitation behavior, drowsiness - mechanical ventilation - intravenous levetiracetam - IV-Immunoglobulins at 2g/kg N/A N/A N/A N/A N/A N/A N/A N/A This is a case report of a 69-year-old patient admitted to ICU for status epilepticus who required endotracheal intubation. He had a medical history of diabetes mellitus, hypertension and a single seizure. The patient was treated with IV-Immunoglobulins. He improved after one week, allowing for weaning from mechanical ventilation, but he presented signs of frontal lobe syndrome. MRI at day 15 showed the persistence of a marked hyperintensity of the right caudate nucleus and a significant decrease of the hyperintensity of the prefrontal cortex, MRI at day 30 was normal. Authors hypothesized that this particular form of orbitofrontal status epilepticus might have been triggered by the passage of SARS-CoV2 through the olfactory pathway
Lee AJY 10.1016/j.physio.2020.06.002 2020 Singapore N/A To describe clinical course and physiotherapy intervention in a sample of COVID-19 patients Descriptive: Case Series Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 9 Out of 9 patients (median age: 66 years), one case (Case 7) with pre-existing asthma/chronic obstructive pulmonary disease overlap syndrome, showing with a dry and unproductive cough, was referred for respiratory care. All the other patients were referred for rehabilitation; of these, exertional and positional-related oxygen desaturation was a common feature in five patients (Case 1, 2, 5, 6, 8). One individual (Case 1) demonstrated severe and persistent postural hypoxaemia (oxygen saturation decreased to <90% when seated upright from a supine position and lasted beyond 4 weeks following ICU discharge).Rehabilitative therapy sessions were organised into small interval sessions with multiple rest breaks in between exercise sets. Interval training was prescribed in the initial stages of the rehabilitation before gradually progressing to continuous training, as the patients were unable to tolerate continuous aerobic exercises. N/A Clinical course N/A N/A N/A N/A N/A N/A Early detection of COVID-19 infection and management and recognition of this phenomenon is mandatory. A tailored rehabilitation approach should be performed in accordance with patient tolerance. A prolonged duration of rehabilitation course may be expected especially for severly ill patients
Longobardi Y 10.1177/0194599820948043 2020 Italy From April 7 to May 11, 2020 To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID- 19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. Analytical: Cohort study Specialized postacute rehabilitation Meso Level N/A N/A Adult laryngectomy patients who use a voice prosthesis 73 N/A - semi structured interviews to inquire about the nature of the need
- on the basis of the answers, telematic contact with the relevant professional figure
- if needed, subsequent outpatient visit		 N/A N/A N/A N/A N/A N/A N/A N/A
  • Out of 73 patients, 37 requested a video call to receive consultation either medical/speech therapy, related to voice prosthesis issue or psychological. Patients that did not request consultation were those who had had a more recent visit.
  • In 62% of the cases the call was sufficient to solve the issue, in the remaining cases an outpatient visit was not postponable
  • Hospital Anxiety and Depression Scale scores decreased significantly comparing pre to post-telematic support
  • All the patients reported a high score at the VAS for satisfaction with service
Maideniuc C 10.1007/s00415-020-10145-6 2020 USA N/A To describe a case of COVID 19 patient with ANM and AMAN, a rare variant of GBS, without systemic signs of infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 with ANM 1 At the admission, the 61-year-old woman showed increased tone in the lower extremities and weakness of upper and lower extremities (worse in the lower ones); reflexes were normal in the upper extremities but brisk in the lower extremities with upgoing toes bilaterally. The patient continued to progress and became quadriparetic. At 3 weeks after her initial onset of symptoms, she was areflexic in all extremities. EMG showed evidence of acute motor axonal neuropathy with normal sensory conductions Methylprednisolone 1 g IV for 5 days without improvements. Then, at 3 weeks she received five rounds of plasma exchange and was discharged to an inpatient rehabilitation setting. N/A N/A N/A N/A N/A N/A N/A N/A The authors reported the first case of COVID 19 patient who presented with GBS and ANM at the same time without any systemic manifestation. Immunotherapy seemed to have a role in immune-mediated neurological conditions associated with COVID-19. The patient started to stand up with the assistance and was able to take few steps with the walker at the rehabilitation facility after the discharge from the Neurology Unit. It is mandatory an early diagnosis and a consequent early management of immuno-mediated neurological conditions associated with COViD-19
Mella-Abarca W 10.3332/ecancer.2020.1085 2020 Chile From April to June 22nd, 2020 To describe a model of physical therapy using telerehabilitation for people with breast cancer during the COVID-19 pandemic in Chile Descriptive: Historical cohort Specialized postacute rehabilitation Meso Level N/A N/A People with breast cancer 118 N/A Telerehabilitation N/A Side effects of breast cancer surgery, including lymphedema, axillary web syndrome, limited movement in the upper limbs and reduced muscle strength N/A N/A N/A N/A N/A N/A This paper describe a model of physical therapy using telerehabilitation for people with breast cancer and report data on its implementation: during the pandemic, 226 care events have been recorded, 142 (63%) of which correspond to tele-rehabilitation in 118 patients. Both patients and physiotherapists reported a high level of acceptance and satisfaction. The model can be implemented in the case of telerehabilitation when face-to-face appointments can not be performed and can be facilitated by:
  1. Having an electronic medical record system which allows legal record-keeping and to establish concrete rehabilitation objectives;
  2. Having a multidisciplinary team which maintains good communication;
  3. The growth in use of technology in the country (wide internet access and smartphones);
  4. Obligatory quarantine, which may enable the company of a family member to assist the patient to manage the technology;
  5. The creation of a webpage with facilitates asynchronous contact with the person;
  6. High levels of commitment and motivation of therapists/patients to participate in this new model.
Mooney B 10.1007/s11420-020-09778-0 2020 USA From April 4, 2020, to May 30, 2020 To determine the outcomes of a collaboration between PT and SLP in the treatment of COVID-19 patients who underwent tracheostomy placement Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 3 Patient 1: A 33-year-old woman. Post-weaning, she exhibited delirium, right upper extremity myopathy/neuropathy, anxiety.
Patient 2: An 81-year-old man. Post-weaning, he produced thick, purulent secretions, a pressure ulcer, constipation, delirium, and respiratory stridor.
Patient 3: An 84-year-old man. Post-weaning, he was diagnosed with toxic metabolic encephalopathy and MRI signs of a subacute stroke. Moreover, he was found to have a pulmonary embolism.		 PT interventions focused on breathing mechanics, secretion clearance, posture, sitting balance, and upper and lower extremity strengthening. SLP interventions focused on cognitive reorganization, verbal and nonverbal communication, secretion management, and swallowing function. N/A Achievement of PT and SLP functional milestones, including mobility, communication, and swallowing. N/A N/A N/A N/A N/A N/A Three patients with COVID-19 received coordinated PT and SLP following prolonged intubation and tracheostomy.
  • Time to tracheostomy from intubation was 23 days, 20 days, and 24 days, respectively. Time from tracheostomy insertion to weaning from the ventilator was 9 days in a case and 5 days for the others.
  • All three patients achieved respective PT and SLP functional milestones, including mobility, communication, and swallowing. The timing of PT intervention in preparation for SLP intervention maximized the improvement of the function of both physical and speech milestones.
  • The results suggest a positive impact of collaborative treatment.
Muhammad S 10.1016/j.bbi.2020.05.015 2020 Germany N/A To report the first case of COVID-19 positive patient presenting with a concomitant subarachnoid haemorrhage from an intracranial aneurysm Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 60-year-old COVID-19 positive patient presenting with a concomitant subarachnoid haemorrhage from an intracranial aneurysm - intubation
- microsurgical clipping of intracranial aneurysm 		N/A N/A N/A N/A N/A N/A N/A N/A
  • This is the first case of COVID19 infection and concomitant aneurysmal subarachnoid haemorrhage from a ruptured pericallosal artery
  • The aneurysm was clipped microsurgically immediately after admission
  • Due to positive SARS-CoV-2 PCR the patient was transferred to a specialized ward where she received treatment for pneumonia
  • Once cured from COVID-19, the patient was transferred for rehabilitation due to poor grade subarachnoid haemorrhage
Negrini S 10.1016/j.apmr.2020.08.001 2020 Italy From January to March, 2020 To investigate the feasibility and acceptability of telemedicine as a substitute for outpatient services in emergency situations such as COVID-19 Descriptive: Historical cohort Specialized outpatient rehabilitation Meso Level N/A N/A Patients with spinal disorders 1207 N/A Usual consultations and physiotherapy during the control and COVID phases, only telemedicine services (telephysiotherapy and teleconsultations) during the telemed phase Control phase of 30 working days including the usual services before the spread of COVID-19 (January 7-February 23); a COVID phase of 13 working days during which there was a surge of usual services before starting telemedicine (February 24-March 14) number of services provided in 3 phases; continuous quality improvement questionnaires N/A N/A N/A N/A N/A N/A During telemed phase, 325 teleconsulations and 882 telephysiotherapy sessions V30were provided in 15 days.
  • There was a rapid decrease ( -39%) of outpatient services from the control to the COVID-19 phase, which partially recovered in the telemed phase for telephysiotherapy (from -37% to -21%) and stabilized for teleconsultation (from -55% to -60%) interventions. Usual face-to-face interventions were required for 0.5% of patients.
  • Patients’ satisfaction with telemedicine was very high (2.8 out of 3).
  • Telemedicine is feasible and allows medical professionals to continue providing outpatient services with a high level of patient satisfaction.
Ntaios G 10.1161/STROKEAHA.120.031208 2020 International January 2020 - May 2020 To assess whether stroke severity and outcomes in patients with acute ischemic stroke are different between COVID-19 and non-COVID-19 patients Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 inpatients with acute ischemic stroke 174 The most prevalent COVID symptoms were fever (55.2%,), cough (53.5%), and dyspnoea (43.7%). The main stroke symptoms were motor (67.8%), dysarthria (46%), and sensory (42%). The median NIHSS was 10. Assessment of stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke Non-COVID-19 patients hospitalized with acute ischemic stroke registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. mRS N/A N/A N/A N/A N/A N/A Forty-eight COVID-19 patients (27.6%) died, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors, 49 (51%) had severe disability at discharge. Patients with COVID-19 resulted to have higher risk for severe disability (median mRS 4 vs 2; p<0.001) and death (OR: 4.3) compared with patients without COVID-19.
Peng M 10.12998/WJCC.V8.I15.3305 2020 China January-February 2020 To present two cases of COVID-19 who received MV and were managed successfully with a sequential weaning protocol Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 2 Fever, cough and fatigue at admission; failed improvement after 2 hours of non-invasive ventilation, requiring MV MV sequential weaning protocol, attentive to the timing of intubation and extubation, early prone positioning (12 hours/day during the first 5 days of MV), infection control, and sequential advancement and withdrawal of invasive ventilation N/A MV weaning N/A N/A N/A N/A N/A N/A Two critical COVID-19 patients with respiratory failure firstly received NIV and, due to the missing improvement after two hours, were following advanced to MV. Using a sequential weaning protocol, the patients were successfully extubated and placed on NIV and, later, on high-flow nasal cannula oxygen therapy. The patients were then transferred from the ICU to the common ward. Based on the good outcomes of the patients, the proposed weaning protocol could be considered for patients with critical COVID-19.
Perrin P 10.1111/ene.14491 2020 France From March 9 to April 9, 2020 To describe the neurological manifestations of patients with COVID-19 and gain pathophysiological insights especially with respect to the CRS Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 5 Neurological presentation included confusion (n = 5), tremor (n = 5), cerebellar ataxia (n = 5), behavioral alterations (n = 5), aphasia (n = 4), pyramidal syndrome (n = 4), coma (n = 2), cranial nerve palsy (n = 1), and central hypothyroidism (n = 3). corticosteroids and intravenous immunoglobulins N/A N/A N/A N/A N/A N/A N/A N/A Neurological disturbances occurred in the second week after COVID-19 onset in 3 cases (in the others, the exact onset was not assessable because of the critical conditions). Neurological disturbances were remarkably accompanied by laboratory evidence of CRS. Brain MRI findings comprised evidence of acute leukoencephalitis (n = 3, of whom one with a hemorrhagic form), cytotoxic edema mimicking ischemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted with recovery from neurological disturbances in two cases. These data indicate that corticosteroids aimed at tackling CRS and IVIg may be effective to control severe neurological disturbances in patients with COVID-19.
Pisano TJ 10.1097/PHM.0000000000001578 2020 USA N/A To report the case of acute SCI with COVID-19 that developed bilateral DVT despite chemoprophylaxis Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Acute non traumatic SCI developing COVID 19 1 At the admission, 48 year old male showed urinary retention, constipation, lower extremity weakness and sensory impairment. MRI revealed multilevel degenerative disk disease with a T11-12 compressive mass of unclear etiology. He was transferred to a tertiary facility for higher level of neurosurgical care with no lower extremity motor or sensory function. Here, after surgical intervention he had T11 AIS A paraplegia. Then, patient had a diagnosis of DVT with a consequent change in his anticoagulation therapy from chemoprophylaxis dosing to therapeutic dosing using a heparin algorithm infusion (1650 units/hour) with a PTT target range of 50-70 seconds. Anticoagulation was transitioned to oral 15 mg rivaroxaban at a dose of 15 mg two times per day on hospital discharge (day 16) The patient underwent a T10-L1 decompressive laminectomy removing of a large extruded T11-12 herniated disc and was started on VTE chemoprophylaxis with heparin 5000 units administered subcutaneously three times N/A N/A N/A N/A N/A N/A N/A N/A The patient presented acute nontraumatic SCI that has an inherent increased risk for VTE, and COVID-19 without significant respiratory symptoms. During hospitalization, the patient developed first extensive bilateral lower extremity deep vein thrombosis despite chemoprophylaxis, and then bilateral pulmonary embolism, despite therapeutic anticoagulation. This case highlights the need for clinicians to have elevated vigilance in regards to screening and treatment for VTE in high-risk patients, such as SCI with a concurrent diagnosis of COVID-19, because might require more aggressive management or interventions.
Quinn L 10.1093/ptj/pzaa128 2020 USA N/A to describe a physical activity coaching program for individuals newly diagnosed with Parkinson Disease and to highlight rapid modifications made to this program in response to the COVID-19 pandemic Analytical: Cohort study Specialized outpatient rehabilitation Meso Level N/A N/A people with early-mid stage Parkinson Disease 27 N/A adaptation to telehealth delivery of a physical activity coaching program which included 1:1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake N/A N/A N/A N/A N/A N/A N/A N/A
  • The ""Engage-PD"", a coaching program for people with newly diagnosed Parkinson Disease, rapidly transitioned to a telehealth platform.
  • The structure of assessments was modified, excluding some tests and adapting all other assessments to video interview.
  • The recruitment rate was larger than expected, reflecting the unique opportunity provided by stay-at-home guidelines
  • All participants who enrolled in the program had access to technology and were able to connect within the first session
Ros-Castelló V 10.1002/mdc3.13025 2020 Spain N/A to report a case of a patient who developed myoclonus after a COVID-19 infection recovery Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 1 At admission: - 5-day history of fever and shortness of breath
- tachypnea
One month after admission:
- progressively disabling myoclonus in upper limbs and negative myoclonus in lower limbs leading to falls		 In ICU:
- high flow oxygen therapy and prone position
- intubation
- lopinavir/ritonavir
- hydroxychloroquine
- ceftriaxone, azithromycin, meropenem
- corticosteroids
- prophylactic doses of low-molecular-weight heparin
After myoclonus onset:
- low doses of clonazepam		 N/A N/A N/A N/A N/A N/A N/A N/A This is the case report of a 72 years old woman who developed myoclonus after a COVID-19 infection. Two days after admission, the patient was intubated due to hypoxemia and treated with antivirals, hydroxychloroquine, antibiotics and corticosteroids an prophylactic LMWH., One month from admission and two weeks from the withdrawal of antibiotics, antivirals and corticosteroids, she developed progressively disabling myoclonus in upper limbs and negative myoclonus in lower limbs. The myoclonus almost disappeared after two days of low doses of clonazepam. Hypoxia was held responsible for myoclonus in light of normal laboratory tests and absence of concomitant medical therapy.
Saeki T 10.1097/PHM.0000000000001545 2020 Japan February 2020 To describe the rehabilitation therapy of a COVID-19 patient who received MV Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 1 Fever and worsening of respiratory conditions, until his percutaneous oxygen saturation was < 80% while receiving 10 L/min oxygen via a non-rebreather maskRehabilitation therapy N/A N/A N/A N/A N/A N/A N/A N/A A 65-year-old man was admitted to ICU and MV started due to worsening of his respiratory condition. Six days after admission, rehabilitation therapy started but limited to positioning, postural drainage and passive mobilisation, while increased to active exercises, standing and stepping, gait and endurance training as the patient’s conditions got better. On day 19, he was extubated and, on day 34, discharged and instructed to continue home exercise. One month after discharge, muscle strength and activity of daily living returned to normal. This report highlights the importance of early rehabilitation in severe COVID-19 patients.
Sakai T 10.2340/16501977-2731 2020 Japan From April 24 to May 24, 2020 To describe the effectiveness and risk management of remote rehabilitation for COVID-19 patients Descriptive: Case Series General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 43 N/A Remote rehabilitation Direct rehabilitation Destination after discharge, PCR results, mobility scores on level surfaces, and Barthel Index total scores Need for intubation and rehabilitation-related complications N/A N/A N/A N/A N/A Eighteen COVID-19 patients underwent remote rehabilitation using a mobile terminal to minimize contact: all of them were discharged home or to a hotel and no serious adverse events were observed. Remote rehabilitation was an effective and safe modality against the transmission of infection and could facilitate rehabilitation of patients in COVID-19 wards. It should be noted that patients in the remote rehabilitation group were significantly younger than those in the direct rehabilitation group and that the most severe cases belonged to the direct rehabilitation group.
Sassone B 10.1097/HCR.0000000000000539 2020 Italy From January 7 to April 6, 2020 To investigate and quantify the reduction of PA in patients with automatic implantable cardioverter-defibrillators for primary prevention of sudden death Analytical: Cross-sectional study N/A Epidemiology - Prevalence N/A N/A Patients with automatic ICDs 24 N/A N/A PA 40 days before the national lockdown began Daily PA (hours/day) was estimated by processing recorded data from ICD-embedded accelerometric sensors used by the rate-responsive pacing systems. N/A N/A N/A N/A N/A N/A
  • During the forced 40-day in-home confinement, a mean 25% reduction of PA was observed as compared with the 40-day confinement-free period
  • To counteract the deleterious effects of physical inactivity during the COVID-19 outbreak, patients should be encouraged to perform indoor exercise-based personalized rehabilitative programs.
Schirinzi T 10.1002/mdc3.13026 2020 Italy From 20th of April to 2nd of May 2020 to remotely investigate the impact of COVID-19 emergency on daily-life of a cohort of Italian PD patients, specifically focussing on the relationship between physical activity changes and the self-perceived health. Descriptive: Historical cohort N/A Epidemiology - Prevalence N/A N/A people with Parkinson Disease 74 N/A N/A N/A motor activity habits before COVID-19 emergency:
- physiotherapy/rehabilitation practice,
- sports practice (type and weekly frequency)
motor activity habits during lockdown:
- physiotherapy/rehabilitation practice
- physical exercise practice (indoor/outdoor, type of activity)
- a self-reported questionnaire to quantify the intensity of physical activity as Metabolic Equivalent (MET) min/week
- use of technology-based tools: previous experience, frequency of current use, opinion on the usefulness
- use of wearable devices
- perception of own health during COVID-19 emergency
- Three self-administered scales: the International Physical Activity Questionnaires – Short Form, the Parkinson’s Well-Being Map (PWBM), the Beck Depression Index		 N/A N/A N/A N/A N/A N/A
  • Because of COVID-19 emergency, the number of patients under physiotherapy/rehabilitation decreased significantly, from 32% to 7%
  • The total number of patients playing sports remained stable
  • 59.5% of patients referred a perception of worsening in their global health during COVID-19 emergency, hese patient had
    • higher scores of both PWBM and BDI
    • lower total MET
  • Binomial logistic regression model indicated that total MET was inversely associated with “worsening” independently from age, age at onset, disease duration, BDI and PWBM total scores
  • TBTs were used by 50% of the whole study population
  • Commercially available wearable devices (as pedometer) were used by 25% of patients
  • Results showed that COVID-19 outbreak, and the subsequent restrictions, had a significant impact on PD patients’ daily-life
Schlachetzki F 10.1177/1357633X20943327 2020 Germany From January to April 2020 To evaluate the effect of the COVID-19 pandemic lockdown on stroke consultations and treatment recommendations using the acute consultant database of the telestroke network TEMPiS Descriptive: Historical cohort N/A Epidemiology - Prevalence N/A N/A Telemedicine consultations in the telestroke network TEMPiS N/A N/A Data collected during the first four months of 2020 Data collected during the same months in the years 2017–2019 Data for presumed and definite ischemic stroke, recommendations for rtPA and EVT N/A N/A N/A N/A N/A N/A
  • The study considered 7608 consultations at 12 clinics without neurology departments in the telestroke network TEMPiS;
  • Compared to the same period in 2017-2019, lower incidences of ischemic stroke and other acute neurological disorders requiring consultation were observed. Moreover, a significant reduction in recommendations for rtPA and a similar level in recommendations for EVT (while it should be noted that they were significantly higher before lockdown in 2020) were observed in the lockdown period (March 16 - April 30), suggesting fewer incidences of ischemic stroke severities;
  • A rebound effect following the lockdown period, with an increased incidence of stroke, as patients’ frailty may have increased during the lockdown due to decreased mobility, can be expected.
Shan MX 10.1136/bcr-2020-237406 2020 USA N/A To report the case of a patient receiving pulmonary rehabilitation following COVID-19 infection Descriptive: Case Report Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 1 At admission:
- 8 days of fever, chills, cough and lethargy and positive outpatient COVID-19 test		 In acute ward:
- intubation
- including hydroxychloroquine, azithromycin, ceftriaxone, vancomycin, cefepime, doxycycline and tocilizumab
During patient’s rehabilitation course
- therapy focused on improving activity tolerance and endurance 		N/A functional outcome measured with multiple assessments:
- the Chair Stand Test
- the Timed Up & Go
- the 6MWT		 N/A N/A N/A N/A N/A N/A This is the case report of an elderly woman who survived COVID-19 and was referred to the Acute Rehabilitation Unit for pulmonary rehabilitation. Patient's functional outcomes, as measured by Chair Stand Test, TImed Up & Go and 6MWT, improved in the 11 days she spend in the rehabilitation unit.
Her gait speed, heart rate, oxygen saturation after ambulation and incentive spirometer volume showed similar improvements.
She was discharged home with a prescription for a rollator as well as home and outpatient cardiopulmonary therapy for continued rehabilitation.
Shariyate MJ 10.22038/abjs.2020.47626.2333 2020 Iran March 2020 To report three cases of COVID-19 patients with fragility hip fractures Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patients with fragility hip fractures developing COVID-19 3 Patient 1: 73 year old male admitted with intertrochanteric femoral fracture, complaining weakness. He was transferred to PACU and was discharged from the hospital after 2 days; he returned to the hospital 3 days after discharge with new onset fever, weakness, dyspnea, and anorexia.
Patient 2: 69 year old male admitted with intertrochanteric femoral fracture, complaining weakness.
Partient 3: 93 year old female admitted with femoral neck fracture; he showed a low grade fever along with cough and feeling of fatigue.		 Patient 1 underwent surgical fixation under spinal anesthesia and intravenous sedation.
Patient 2 was treated in a same manner as was done for Patient 1.
Patient 3: the authors urged to postpone surgery due to severe pulmonary involvement in the patient.
All three patients received oseltamivir and hydroxychloroquine. One patient also received corticosteroid.		 N/A N/A N/A N/A N/A N/A N/A N/A Elderly patients with fragile lower extremity fractures are at high risk of COVID-19. The authors recommended careful assessment using chest CT scan and other lab tests.
Tan GP 10.1016/j.resp.2020.103515 2020 Singapore From January 29 to May 29, 2020 To describe the clinical characteristics and outcome of individuals affected by COVID-19 and Platypnea orthodeoxia syndrome-POS Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 5 Oxygen desaturation, dyspnea and tachypnea during physiotherapy when sat up from a recumbent position A modified physiotherapy approach including bed exercises, pre-emptive increases in supplemental oxygen in anticipation of movement and/or exercise, and interval training with multiple breaks N/A N/A N/A N/A N/A N/A N/A N/A During physiotherapy when sat up from recumbent position, five out of 20 ICU survivors presented POS, a clinical syndrome characterized by orthostatic oxygen desaturation and positional dyspnea from supine to an upright position. A modified physiotherapy approach was instituted: bed exercises, pre-emptive increases in supplemental oxygen in anticipation of movement and/or exercise, and interval training with multiple breaks. POS resolved over a median (range) of 17 (6–39) days. Compared to ICU survivors without POS, patients with POS were older and had lower body mass index. POS is an under-recognized clinical feature in severe COVID-19 ARDS and should be considered by healthcare personnel.
Tenforde MW 10.15585/mmwr.mm6930e1 2020 USA From April 15 to June 15, 2020 To interview adults tested positive at an outpatient visit about symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether they had returned to their usual state of health at the time of interview Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 outpatients 274 N/A Telephone interview, 2-3 weeks after testing N/A Baseline chronic medical conditions, symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether subjects had returned to their usual state of health at the time of interview N/A N/A N/A N/A N/A N/A
  • 274 (94%) out of 292 patients reported one or more symptoms at testing;
  • Return to Usual State of Health: Ninety-five (35%) reported that they had not returned to their usual state of health at the time of interview (median 16 days from test to interview (IQR = 14–19 days)) - AGE: 26% of the interviewees aged 18–34 years, 32% aged 35–49 years, and 47% aged ≥50 year - CHRONIC CONDITIONS: 28% of the interviewees with no or one chronic medical condition, 46% with two chronic medical conditions, and 57% with three or more chronic medical conditions;
  • Resolution of Symptoms and Duration: Fatigue (71%), cough (61%), and headache (61%) were the most commonly reported symptoms at the time of testing; among respondents reporting cough, fatigue, or shortness of breath at the time of testing, 43%, 35%, and 29%, respectively, continued to experience these symptoms at the time of the interview;
  • COVID-19 can result in prolonged illness even among persons with milder outpatient illness, including young adults with no chronic medical conditions.
Trifan G 10.1016/j.jstrokecerebrovasdis.2020.105167 2020 USA N/A To report the case of a young female with history of CADASIL with COVID-19 with acute ischemic stroke as the sole manifestation. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patients with CADASIL developing acute stroke and COVID-19 1 A 37 years old African American female with a genetically proven CADASIL mutation referred to ICU presenting with left leg weakness, dysarthria and ataxia. MRI brain without contrast revealed an acute ischemic stroke in the right pons along with extensive chronic white matter signal abnormalities characteristic of CADASIL. N/A N/A N/A N/A N/A N/A N/A N/A N/A The authors reported a paradigmatic case of a woman with CADASIL and positive to SARS-CoV2 showing an acute stroke. They affirmed that CADASIL associated imaging changes have remained stable throughout the years. Thus, while it is possible that SARS-Cov-2 infection may have contributed to the etiology of the acute pontine stroke, the authors could not conclusively prove the causation.
Turgut A 10.5152/j.aott.2020.20209 2020 Turkey From March 16 to May 22, 2020 To evaluate the types and the frequency of fractures, both in the pediatric and adult population during the COVID-19 pandemic and to find out the differences in comparison to the non-pandemic period. Analytical: Cross-sectional study N/A Epidemiology - Prevalence N/A N/A Patients with a new fracture 3996 N/A N/A Patients with new fractures admitted to the hospital in the same date range in 2018 and 2019. N/A N/A N/A N/A N/A N/A N/A The frequency of fractures decreased by approximately one-third during the pandemic period compared with that in the non-pandemic period (1794, 1747, 670 fractures in 2018, 2019, and 2020, respectively). The mean age of the patients with a fracture in the pediatric group was found to have decreased also. Finger fractures in pediatric patients and metatarsal fractures in adult patients were found to have significantly decreased during the pandemic. The decreased mobility on the streets directly affects the fracture frequency.
Vitali M 10.1016/j.tcr.2020.100336 2020 Germany and UK March-April 2020 To report a case of axillary nerve palsy in a patient affected by COVID-19 who kept a wrong decubitus position while receiving CPAP therapy. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 1 A 46 year-old Caucasian male referred to ICU with shortness of breath, body temperature 38 °C and RR=30 breaths per minute; oxygen saturation was 95% on room air. An orthopedic consult revealed that patient had left shoulder abduction and extension limited to 45° each, left deltoid muscle hyposthenia of 3⁄4 on MRC, without sensitivity disturbances. CPAP four times a day for 3 h each time, alternating with Venturi oxygen mask with 60% FiO2 oxygen flow and a cycle of passive physical therapy N/A N/A N/A N/A N/A N/A N/A N/A This clinical case highlights an uncommon side effect, axillary nerve compression, that might occur while keeping the lateral decubitus for a long time during CPAP.
  • Healthcare workers have to be aware of this possible complication and must implement proper precautions to prevent it and its further disability.
  • In order to avoid peripheral nerve compression, it's important to maintain a proper body positioning, to change the side of the lateral decubitus, and to abduct the arm of the patients during invasive and non- invasive mechanical ventilation
Weerahandi H 10.1101/2020.08.11.20172742 2020 USA N/A To characterize overall health, physical health and mental health of patients one month after discharge for severe COVID-19 Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 patients 161 N/A N/A N/A - degree of residual pulmonary impairment
- overall health status and mental health		 N/A N/A N/A N/A N/A N/A
  • 152 of 161 patients discharged home after severe COVID-19 completed the survey (consisting of PROMIS® Dyspnea Characteristics and PROMIS® Global Health-10, two validated survey instruments)
  • 36.8% required home oxygen on hospital discharge and for 92,9% of them home oxygen was a new requirement 74.3% participants reported some shortness of breath, compared to 30.9% pre-COVID-19 infection
  • For those that did have shortness of breath prior to COVID-19, intensity, frequency, and duration of the shortness of breath worsened after COVID-19
  • The PROMIS® Global Health-10 instrument scores indicated worse general health after COVID-19 illness compared to baseline, with significantly lower score in the physical health and mental health domains
  • Patients also reported worsened ability to carry out social activities after COVID-19
Whittemore P 10.1136/bcr-2020-236586 2020 UK N/A To present a case of a 60-year-old man who developed extensive COVID-19 pneumonitis and was successfully managed with low-flow oxygen and awake proning Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 1 Significant and worsening shortness of breath, COVID-19 symptoms and SpO2 of 88% Awake proning N/A SpO2, need of MV N/A N/A N/A N/A N/A N/A A 60-year-old man with extensive COVID-19 pneumonitis was successfully managed with low-flow oxygen therapy and awake proning, avoiding the need of increasing oxygen therapy or of invasive MV, and discharged home. Awake proning, lasting as much as possible but ideally at least 18 hours/day, could be used in mechanically ventilated as well as non-mechanically ventilated patients to improve oxygenation and avoid the need of MV.
Wurm H 10.1177/1352458520943791 2020 Germany and UK April 2020 To report the case of a MS patient who had received B-cell-depleting immunotherapy with rituximab for about 3 years and developed COVID-19 symptoms Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patient with relapsing MS developing COVID-19 1 A 59-year-old female MS patient showed mild paraparesis and paraspasticity and a limited walking distance; after 4 days she devolped dry cough, dyspnea, fatigue, headache, nausea, fever of 39°C and low oxygen saturation Prophylactic IV antibiotic (ampicillin/sulbactam) N/A N/A N/A N/A N/A N/A N/A N/A This MS patient, in treatment with immunotherapy for 3 years, recovered 14 days after COVID-19 symptoms onset despite having a 0% B lymphocyte count and not developing SARS-CoV-2 IgG antibodies. This case suggests that MS patients receiving B-cell-depleting therapy are not at higher risk of severe complications from primary SARS-CoV-2 infection, and demonstrates that viral clearance is possible without B-cell involvement and antiviral therapy.
Zha L 10.21037/apm-20-753 2020 China From March 4, 2020 to May 5, 2020, To present a modified version of rehabilitation exercises aimed at improving the pulmonary function of patients and easing the expectoration process with acupressure integrated into the exercises to facilitate the recovery and maintenance of pulmonary function Analytical: Cohort study Rehabilitation in acute care Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 60 At baseline the prevalence for dry cough, productive cough, difficulty in expectoration and dyspnea were 41.7%, 43.3%, 35.0% and 50.0%, respectively Modified rehabilitation exercise which is a full-body exercise retrieved from Chinese martial art Eight-section Brocade N/A Over time prevalence of self-reported symptoms of: - Dry cough - Productive cough - Difficulty in expectoration - Dyspnea N/A N/A N/A N/A N/A N/A The current study found that pronounced improvement occurred in all four investigated respiratory symptoms in COVID-19 patients who performed the Modified rehabilitation exercise during both hospitalization and quarantine period. In particular, after one month, the prevalence rates were - 11.7% in dry cough,
- 11.7% in productive cough,
- 8.3% in difficulty in expectoration
15% of patients reported dyspnea as a remained symptom.

Abbreviations: 6Abbreviations: AIS= American Spinal Injury Association Impairment Scale; AMAN= acute motor axonal neuropathy; ARDS= Acute Respiratory Distress Syndrome; ANM= acute necrotizing myelitis; ATM= Acute Transverse Myelitis; BD= Bis in Die; BDI= Beck Depression Index; CADASIL= Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy; CHD= Congenital Heart Disease; CIRS= Cumulative Illness Rating scale; COVID-19= Coronavirus Disease 2019; CPAP= continuous positive airway pressure; CR= cardiopulmonary rehabilitation; CRS= cytokine release syndrome; CRQ=Chronic Respiratory Questionnaire; CVST= cerebral venous sinus thrombosis; DMS= Direct Muscle Stimulation; DVP= deep vein thrombosis; EMG= Electromyography; EVT= endovascular thrombectomy; FIM= Functional Independence Measure; FT= Feeling Thermometer; GBS= Guillain–Barré Syndrome; HADS= Hospital Anxiety and Depression Scale; HFNC= high-flow nasal cannula; ICD= implantable cardioverter-defibrillators; ICH= intracerebral haemorrhage; ICU= Intensive Care Unit; IPF= Idiopathic Pulmonary Fibrosis; IQR: Interquartile Range; LMWH= Low-molecular-weight heparin; MET= metabolic equivalent of task; MRC= Medical Research Council; MRI= Magnetic Resonance Imaging; mRS= modified Rankin Scale; MS= multiple sclerosis; MV= Mechanical Ventilation; NCS= Nerve Conduction Studies; NIHSS= National Institute of Health Stroke Scale; NIV= noninvasive ventilation; NRS= noninvasive respiratory support; OD= Omne in Die; OR= odds ratio; PA= Physical Activity; PCR= Polymerase Chain Reaction; POS= Platypnea-Orthodeoxia Syndrome; PT= physical therapy; PTT= partial thromboplastin time; PWBM= Parkinson’s Well-Being Map; RR= respiratory rate; rtPA= intravenous thrombolysis; SARS-Cov2= Severe Acute Respiratory Syndrome Coronavirus 2; SCI= spinal cord injury; SLP= speech language pathology; SpO2= oxygen saturation; TIA= Transient ischemic attack; TDS= Ter Die Semendum; UK= United Kingdom; USA= United States of America; VTE= venous thromboembolism; 6-MWT= 6-minute walk test 

Reference: De Sire A, Andrenelli E, Negrini F, Lazzarini SG, Patrini M, Ceravolo MG; The International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Update as of August 31st, 2020. Eur J Phys Rehabil Med 2020 Oct 01.
DOI: 10.23736/S1973-9087.20.06614-9