The SARS Cov 2 virus predominantly affects the respiratory system, as being evidenced globally, however, neurological symptoms and complications are also being noted with increasing number of cases. Similar neurological complications were also witnessed with the SARS CoV 1 and MERS-Cov, with scientists attributing it to CoV neurotropism, direct invasion of the central nervous system (CNS) by the virus as well as post infection neurological complications.
Coronaviruses are a group of large, RNA viruses that have known to invade the CNS, disseminate and participate in the induction of neurological diseases.
With respect to the ongoing SARS CoV 2 pandemic, acute cerebrovascular diseases, Guillian-Barre syndrome and encephalitis have been emerging as a complication, post-recovery. Studies conducted with cohorts have also reported strokes in 2-6% of patients hospitalized with COVID-19, and has become a cause for worry as these neurological manifestations increase the health and socio-economic burden on the patients as well as on an already overwhelmed health care system.
These neurological manifestations are related to – involvement of the central nervous system (CNS), involvement of the peripheral nervous system (PNS) as well as to skeletal muscle injury or neuromuscular junction (NMJ) disorders. Severe neurological symptoms, although not very frequent, have been noted in a large portion of patients and include strokes, seizures, neuropathies, coma and encephalopathy.
Acute ischemic strokes (AIS) or transient ischemic attacks (TIA) experienced by patients with COVID-19 have been linked to coagulation abnormalities that occur in critically ill patients. These abnormalities elevate procoagulant factors like fibrinogen, platelets, interleukin-6 and D-Dimer that increase the risk of thromboembolic events, leading to a higher rate of morbidity and mortality. Inflammatory responses (elevated C-reactive protein, IL-7) in the body, also occur due to the SARS CoV 2, leading to increased ischemic events in patients, often causing arterial wall ruptures that may also occur due to spike in blood pressure.
With regard to movement disorders, only a few cases have been reported till date that includes myoclonus (positive and negative jerks) with predominant involvement of the facial, sternocleidomastoid, trapezius and upper extremity muscles.
Some hospitals have also reported skeletal muscle injury and myopathy in patients with severe COVID-19 illness occurring due to respiratory distress, systemic inflammatory response, sepsis and direct invasion of muscles by the virus along with hyper-inflammation and cytokine storms that lead to immune-mediated muscle damage.
Since the number of patients with COVID-19 are increasing with each passing day, there is a need to consider myopathy as a major cause of long-term physical disability, post COVID-19 and work out a multi-disciplinary rehabilitation program. Moreover, neurological conditions also make the patients vulnerable to secondary events, due to lack of access to appropriate rehabilitation care.
Such neurological and musculoskeletal complications lead to muscle contracture, loss of movement, spasticity and sensory loss, thus, requiring a neurorehabilitation program tailored to the patient that will enable nerve repair. To prevent further deterioration and to aid in supporting these deformities, biomechanically fabricated and well aligned orthotics, together with manual therapy, play a positive role on the patient’s rehabilitation. Specific orthoses are designed to assist patients dealing with neurological complications to achieve their goals as these orthotic devices help to maintain muscle and soft tissue length and also prevent the formation of joint contractures.
Recovered patients should be educated to consult with rehabilitation professionals who can assist the patients in their neuro-functional recovery by designing a neurorehabilitation program including physical therapy, assistive device fabrication as well as counselling and support.
Contact our team of multi-disciplinary professionals at Invigo Rehab for a safe & customized neuro-rehabilitation program, brought to you safely at home.
REFERENCES
Ellul M et al. Neurological associations of COVID-19. Rapid Review 19(9); (767-783)
Sharifian-Dorchea M, Huota P, Osherova M, Wen D. Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. Journal of Neurological Sciences 417 (2020)117085
Joshua Young & Cameron Moss. Orthotic care needs in a cohort of neurological rehabilitation inpatients. Disability and Rehabilitation: Assistive Technology (2019)